Glover Joe, Kovacevic Gorana, Walton Gary, Parr David
University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
BMJ Case Rep. 2020 Mar 31;13(3):e233971. doi: 10.1136/bcr-2019-233971.
Management of sore throat requires robust decision-making to balance successfully the conflicting risks of unnecessary antibiotic use against those of untreated bacterial infection. We present a case of fulminant sepsis caused by presenting as a sore throat, initially managed conservatively. Despite subsequent appropriate anti-microbial therapy and surgical drainage, contiguous spread ultimately involved the deep neck spaces, mediastinum and thoracic wall, and was complicated by severe aspiration pneumonia, pharyngocutaneous and bronchopleural fistulation. The complexity and widespread extent of the infected spaces, in conjunction with the catabolic response to sepsis, created a life-threatening situation. Surgical closure of the pharyngeal defect, using a pectoralis-major pedicle flap, was successfully undertaken to ensure source control of the infection and heralded a complete recovery. We describe our management of this case, discuss the current approach to the management of patients presenting with a sore throat, and review the literature on infections.
咽喉痛的管理需要做出有力的决策，以成功平衡不必要使用抗生素的风险与未治疗细菌感染的风险之间的冲突。我们报告一例以咽喉痛为表现的暴发性脓毒症病例，最初采用保守治疗。尽管随后进行了适当的抗菌治疗和手术引流，但感染仍蔓延至颈部深部间隙、纵隔和胸壁，并并发严重吸入性肺炎、咽皮肤瘘和支气管胸膜瘘。感染部位的复杂性和广泛性，以及脓毒症引起的分解代谢反应，造成了危及生命的情况。成功采用带蒂胸大肌皮瓣对咽缺损进行手术闭合，以确保感染源得到控制，并预示着患者完全康复。我们描述了该病例的治疗过程，讨论了目前对咽喉痛患者的治疗方法，并回顾了关于感染的文献。
