A 15-YEAR-OLD GIRL presented to her primary care physician with complaints of sore throat, odynophagia, and fever and symptoms of upper respiratory infection. A 7-day course of clarithromycin was prescribed for tonsillitis. Over the next 2 days, the patient continued to have severe odynophagia and fever (temperatures to 39°C) and then acutely developed mental status changes with hallucinations. She was taken to a local hospital for evaluation. She had an elevated white blood cell count, but normal results on her serum chemistry profile. Blood cultures were drawn, and tests for Lyme disease and Rocky Mountain spotted fever were negative. The results of a computed tomographic scan of the head and neck at that time were reportedly normal. With aggressive fluid resuscitation and intravenous penicillin therapy, the patient defervesced and her mental status returned to normal. She was discharged 24 hours after admission on a regimen of oral penicillin. The next day, she developed swelling and pain in the right side of her neck, with worsening odynophagia, and presented to our institution.
Holland BW, McGuirt WF. Imaging Quiz Case 2. Arch Otolaryngol Head Neck Surg. 2000;126(12):1500-1504. doi: