Lemierre's Syndrome: A Case Report.

Lemierre's syndrome is a rare condition characterized by septic thrombophlebitis of the internal jugular vein secondary to infection of the head and neck region and septic embolization to other organs. The most frequent etiological agent is Fusobacterium necrophorum, a commensal anaerobic gram-negative bacillus of the oral flora. We report the case of a young male who presented with chest pain after a dental procedure. He developed a masseterian phlegmon, thrombosis of the internal jugular vein, and embolization to the lung complicated by empyema. The diagnosis of Lemierre's syndrome was delayed by the negative blood cultures, but full recovery was achieved after appropriate broad-spectrum antibiotic coverage. Our main objective is to highlight the fact that a high clinical suspicion is required to establish the diagnosis of this rare syndrome.

A Case of Anti-Caspr2 Autoimmune Encephalitis Associated with Adenocarcinoma of the Lung.

Autoimmune encephalitis (AIE) is an inflammatory brain condition with multiple aetiologies but is mainly associated with paraneoplastic syndromes. Several antibodies described in AIE are being investigated in relation to different cancers, including antibodies against Contactin-associated protein-like 2 (Caspr2), which have been associated with thymoma but very rarely with lung cancer. The authors present the case of a 72-year-old man with cardiovascular risk factors, who presented with a 3-week history of left hemichorea following a first unprovoked seizure the week before, with no other signs or symptoms. The patient was submitted to extensive aetiological investigation, testing positive for anti-Caspr2 antibodies in the cerebrospinal fluid. AIE was diagnosed after other possible causes had been excluded. A PET scan showed signs of abnormal metabolism, with a lung biopsy confirming lung adenocarcinoma. This case highlights a very rare association and the importance of a thorough aetiological investigation for neurological complaints. LEARNING POINTS: Neurological complaints require a thorough aetiological investigation, and positive findings on imaging studies must be carefully examined.Anti-Caspr2 antibodies are classically associated with Morvan syndrome, but other neurological presentations must also be considered.Anti-Caspr2 autoimmune encephalitis may be the primary presentation of lung adenocarcinoma.

Pyogenic Liver Abscess and Delayed Massive Gastrointestinal Bleeding Following Endoscopic Retrograde Cholangiopancreatography (ERCP): Association of Two Rare Complications.

A liver abscess (LA) is the most common type of visceral abscess. While biliary tract disorders are its most common etiology, clinicians should also consider less frequent causes such as iatrogenic complications due to certain interventions. One of these unusual causes is related to endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES), a usually safe procedure that carries some risk of complications. We present the case of a 71-year-old female with a history of choledocholithiasis who underwent ERCP with ES without any immediate complications; she was discharged after 24 hours and readmitted three days later to the emergency room with fever and abdominal pain. An abdominal CT showed a liver abscess. Blood cultures were positive for Escherichia coli, Streptococcus anginosus, and Enterococcus faecalis, and the patient was started on directed antibiotic therapy with ampicillin, benzylpenicillin, and metronidazole. On day 17, due to hematochezia with hemodynamic instability, an urgent upper gastrointestinal endoscopy was performed, which revealed late post-ES bleeding, refractory to conventional endoscopic therapy. An ERCP was performed to control the bleeding by using a biliary fully covered self-expandable metal stent (FCSEMS), which was removed four weeks later. The follow-up CT showed a significant reduction of LA and the patient was discharged. This case highlights the association of two uncommon complications of ERCP: a LA and a major late post-ES bleeding. Clinicians should maintain a high index of suspicion for these complications in daily practice.

An Uncommon Cause of Acute Pancreatitis in a Patient With COVID-19.

Drug-induced pancreatitis is a rare though important condition that remains a diagnostic challenge. Most of the evidence relies on case reports, and clinicians should consider a high suspicion of the diagnosis after ruling out other causes. In particular, steroids are frequently used drugs that have recently been associated with acute pancreatitis. The authors present the case of a 60-year-old female admitted to the emergency room with a fever and shortness of breath. The SARS-CoV-2 test was positive, and the chest radiography was suggestive of COVID-19 pneumonia. The patient started dexamethasone because of respiratory failure. On Day 7, she developed epigastric pain radiating to the back and the amylase level was greater than 10 times the upper reference limit (1354 U/L). A detailed evaluation of the medical history, along with the exclusion of other possible etiologies confirmed the diagnosis of steroid-induced pancreatitis. Supportive care and cessation of the offending drug led to the resolution of symptoms. As steroids are used as part of the treatment of most COVID-19 patients, this case suggests the need to consider this entity, as a delay in the diagnosis may result in complications and prolonged hospital stay.