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Case report: 16 years old patient with moraxella catarrhalis sepsis with cervical phlegmone and acute pansinusitis in metamizole-induced agranulocytosis
Introduction Metamizole is one of the most commonly prescribed analgesics. Agranulocytosis is a rare side effect of taking metamizole. Delayed diagnosis can lead to severe sepsis and multiorgan failure.
Case We report a 16-year-old female patient who initially presented to the pediatrician with sore throat and dysphagia and was treated with cefuroxime. The mother also reported a chronic painkiller abuse of her daughter with metamizole caused by former sexual abuse in early childhood. In the absence of symptom relief and high fever, an emergency presentation was made in a peripheral emergency room with a diagnosis of agranulocytosis. The antibiosis was escalated, in the smear and in the blood culture Moraxella catarrhalis showed up. The patient was intubated and ventilated to a pediatric intensive care unit. For focus search a CT-neck with detection of a cervical phlegmon and acute pan-sinusitis was performed. The patient was transferred to our ENT clinic for focus source control in the sense of an endonasal pansinus operation. Only after extensive intensive care did the number of complaints decrease, so that the young patient could be transferred to a neurological early rehabilitation.
Discussion Clinically, agranulocytosis often initially manifests itself through sore throat, dysphagia and cephalgia, so that the ENT physician is particularly important in the initial contact for preventing fulminant intensive care.
Article published online:
10 June 2020
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