RESUMO
Lemierre's syndrome is a rare and a life-threatening disease characterized by anaerobic bacteraemia associated with thrombosis of the internal jugular vein. Odynophagia, otalgia, odontalgia, dyspnoea, cough and fever are the most frequent manifestations. We describe a case of a 37-year-old woman who was admitted to the emergency room due to fever, odynophagia, dyspnoea, myalgia, and pleuritic chest pain. She had hypoxaemia and increased systemic inflammatory markers. The chest CT showed parenchymal densification compatible with severe acute respiratory syndrome coronavirus infection, although all three polymerase chain reaction testing were negative. The neck CT showed occlusion of the left cervical internal jugular vein. She was treated with antibiotics and was discharged. With the reported clinical case the authors intend to clarify the importance of differential diagnosis and the diagnosis of other infectious respiratory conditions at the time of a global pandemic.
RESUMO
Pellagra is a deadly nutritional disease caused by niacin deficiency. Although practically eradicated in developed countries, it still affects vulnerable populations. The diagnosis is based on the presence of characteristic dermatitis in sun-exposed areas, diarrhea, and dementia. We report the case of a woman with a clinical picture of hyperpigmentation and hyperkeratinization in exposed areas of the skin, watery diarrhea, and progressive disorientation with disorganized speech. The anamnesis revealed a poor diet regimen composed almost exclusively of cassava root meals. Alternative diagnosis was excluded and nicotinamide supplementation was introduced with progressive resolution of symptoms until complete recovery. This case report highlights the need to maintain a high index of suspicion in the presence of characteristic symptoms for timely diagnosis of this deadly condition with a simple but dramatic curative treatment.
