Swallod neck, resuscitation , no diagnosis so far | Figure 1

DorinaGobolMd

Otolaryngology Resident

Swollod neck, resuscitation, no diagnosis so far

Case Summary

43 years old male patient without any previous diseases came in to our ENT emergency department 1 week ago with a swollen neck, swollen lymph nodes, difficulty of breathing and swallowing. Covid PCR negative.

Physically we saw that the tonsils, the uvula, and the neck are swollen and painful. We started IV Augmentin at this point which was later changed to Tazobactam/piperacillin. First blood work showed high d-dimer, GOT, GPT, GGT, CRP and a low GFR. Chest X-ray was negative. Neck ultrasound showed fluid in between the fascia of the neck. Neck and Chest CT with contrast showed inflammation in the tonsils and the supraglottic area and edema in the neck; also showed no embolism in the lungs. Second blood work showed a higher CRP, high procalcitonin and a low platelet count. Meanwhile, the patient's status was worsening, so we decided to move the patient to the ICU. Arterial blood gas examination showed extreme hyperkalemia. Meanwhile, while trying to stabilize, the patient's heart stopped and needed resuscitation. The patient was put on monitoring and intubated, but later was successfully extubated. Hemoculture was negative. Culture from the pharynx showed Pseudomonas Aeruginosa. Bone marrow biopsy came back with no proof of any type of leukemia. Repeated neck ultrasound showed no abscess or thrombosis. Repeated CTA showed minimal regression, still no sign of any thrombosis. At this point, there is some regression but still no diagnosis.