A 19 year old man presents with swelling and discomfort of the right side of his neck for 1 day, in a background of fever, a sore throat and difficulty in swallowing for 6 days. His symptoms have progressively worsened over time, even though he was started on oral Erythromycin 3 days ago. His medical and family histories are unremarkable. A full blood count is significant for a leukocyte count of 12,600/mm3 (93% Neutrophils).
A gram stain reveals pleomorphic, gram-negative bacilli. The culture results will be available in 3 days.
There is a tubular hypodensity suggestive of right internal jugular vein (IJV) thrombosis; parapharyngeal soft tissue edema is present. A small lesion is also visualized in the upper lobe of the right lung.
There are multiple, peripheral, ill defined nodules in both lung fields. Bilateral blunting of the costophrenic angles is noted.
Culture results will be available in 3 days.