Group A Streptococcus Necrotizing Lymphadenitis: A Case Report.

Necrotizing lymphadenitis (NL) is a rare entity that can occur as a complication of bacterial cervical lymphadenitis (CL) and is characterized by unilateral or bilateral cervical lymphadenopathy. NL most commonly presents in females and most reports have been in Japan. In this case, we present a 37-year-old male with no significant past medical history who presented with an unusual presentation and clinical course of NL. Initial workup for Epstein-Barr Virus (EBV) and other infectious etiology was negative. Yet, aspiration later revealed Group A Streptococcus. When the patient's pain and swelling did not subside with the initial antibiotic and supportive treatment, the patient underwent a repeat aspiration and biopsy that revealed a necrotic mass or lymph node. NL is uncommon and rarely due to infectious etiology. However, this marks a case in which a Group A Streptococcus was shown to be associated with subsequent necrotic lymph nodes and should allow practitioners to further consider an infectious etiology in the differential diagnosis of NL.

An Unusual Case of Zero Percent Coagulopathic Factor in a Patient With Polymyalgia Rheumatica.

We present a case of a 74-year-old male with a past medical history of polymyalgia rheumatica that presented as a transfer for evaluation of hematomas of the scrotum, left groin, back, and bilateral thighs. Further questioning revealed hematuria and bleeding gums for the past month. The patient complained of left thigh pain without recent fever, chills, chest pain, or shortness of breath. A physical exam showed hematomas of the left groin, scrotum, bilateral thighs, and back with an ecchymotic appearance.  Initial pertinent laboratory workup showed decreased hemoglobin, leukocytosis, and elevated partial thromboplastin time (PTT). Therefore, a decision was made to obtain a CT angiogram of the abdomen and pelvis, which revealed retroperitoneal hematoma. Further diagnostic workup showed a coagulation factor VIII level of zero percent and mixing studies supporting the presence of an acquired factor VIII inhibitor. Therefore, the patient was treated with rituximab and recombinant factor VIIa, with an improvement of factor VIII levels to normal limits within a week.