Ear?
Brain MRI: findings consistent with right ear otomastoiditis complicated by meningitis.
Blood?
Aerobic blood cultures: negative. Smears: positive for Plasmodium vivax.
Lungs?
Chest CT: multiple randomly distributed bilateral lung nodules with cavitations. Highly suggestive of septic pulmonary emboli.
In endemic settings, a partial immunity to malaria can result in asymptomatic infection. Also, non-Falciparum malaria is unlikely to be the cause of neurological manifestations seen in this case. Case closed, right? But there’s a twist.
The story doesn’t end here.
During hospitalization patient developed painful neck and right arm swelling. US revealed extensive thrombosis of internal jugular, axillary and subclavian veins.
1° infection (chronic suppurative
Otogenic Lemierre syndrome
otitis media, mastoiditis)
Here are a few more clues: -Thrombocytopenia—a common finding in invasive infections with Fusobacterium necrophorum. -Subacute presentation. That means there’s a hidden abscess. At the same time, septic pulmonary emboli point to an endovascular infection.
Septic pulmonary embolism
Septic IJV thrombophlebitis
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