{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T18:16:14Z","timestamp":1757614574570,"version":"3.44.0"},"reference-count":7,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Arch Dis Child Educ Pract Ed"],"accepted":{"date-parts":[[2020,10,10]]},"published-print":{"date-parts":[[2022,8]]},"abstract":"A 2-year-old previously well child presented to the emergency department with temperatures and lethargy. He was pale and looked unwell. He received a fluid bolus and was commenced on intravenous ceftriaxone. Pus was discharging from his left ear with postauricular swelling and erythema. Given clinical concerns, urgent neuroimaging was arranged.<\/jats:p>\n \n Question 1<\/jats:title>\n What does the CT scan of head show (figure 1)?<\/jats:p>\n \n Figure 1<\/jats:label>\n \n Enhanced CT showing external and middle ear infection with skull base osteomyelitis.<\/jats:p>\n <\/jats:caption>\n \n <\/jats:fig>\n \n \n Acute subdural collection<\/jats:p>\n <\/jats:list-item>\n \n Acute mastoiditis secondary to sinusitis<\/jats:p>\n <\/jats:list-item>\n \n Enhanced cerebral lesions<\/jats:p>\n <\/jats:list-item>\n \n Meningitis with abscess formation<\/jats:p>\n <\/jats:list-item>\n \n Middle ear infection with skull base osteomyelitis<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n A subsequent MRI scan was performed (figure 2).<\/jats:p>\n \n Figure 2<\/jats:label>\n \n MRI shows thrombus in left jugular vein, and MRA demonstrates occlusion of left internal carotid artery secondary to carotid sheath infection.<\/jats:p>\n <\/jats:caption>\n \n <\/jats:fig>\n <\/jats:sec>\n \n Question 2<\/jats:title>\n What do these two images show?<\/jats:p>\n \n \n Left jugular vein dissection with subdural haematoma<\/jats:p>\n <\/jats:list-item>\n \n Left jugular vein thrombus and carotid artery occlusion<\/jats:p>\n <\/jats:list-item>\n \n Posterior fossa tumour<\/jats:p>\n <\/jats:list-item>\n \n Right sided posterior communicating artery aneurysm<\/jats:p>\n <\/jats:list-item>\n \n Skull base abscess<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>\n \n Question 3<\/jats:title>\n What is the most likely diagnosis?<\/jats:p>\n \n \n Acute mastoiditis secondary to chronic sinusitis<\/jats:p>\n <\/jats:list-item>\n \n Cerebral tuberculosis (TB)<\/jats:p>\n <\/jats:list-item>\n \n Hereditary thrombophilia (protein S deficiency)<\/jats:p>\n <\/jats:list-item>\n \n Lemierre\u2019s syndrome<\/jats:p>\n <\/jats:list-item>\n \n Non-accidental head trauma (NAI)<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>\n \n Question 4<\/jats:title>\n What is the most commonly identified organism in this syndrome?<\/jats:p>\n \n \n \n Candida albicans<\/jats:italic>\n <\/jats:p>\n <\/jats:list-item>\n \n \n Fusobacterium necrophorum<\/jats:italic>\n <\/jats:p>\n <\/jats:list-item>\n \n \n Haemophilus influenza<\/jats:italic>\n <\/jats:p>\n <\/jats:list-item>\n \n \n Staphylococcus aureus<\/jats:italic>\n <\/jats:p>\n <\/jats:list-item>\n \n \n Streptococcus pyogenes<\/jats:italic>\n <\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n \n Answers can be found on page XX.<\/jats:italic>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/archdischild-2020-320122","type":"journal-article","created":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T17:21:37Z","timestamp":1605028897000},"page":"268-270","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["A common complaint\u2026 a rare disease!"],"prefix":"10.1136","volume":"107","author":[{"given":"Mary-Beth","family":"Toner","sequence":"first","affiliation":[{"name":"Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seana","family":"Molloy","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2634-7785","authenticated-orcid":false,"given":"Peter","family":"Mallett","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK"},{"name":"Paediatric Infectious Diseases, Royal Belfast Hospital for Sick Children, Belfast, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynne","family":"Speirs","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK"},{"name":"Paediatric Infectious Diseases, Royal Belfast Hospital for Sick Children, Belfast, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,11,10]]},"reference":[{"key":"2025090501554053000_107.4.268.1","doi-asserted-by":"publisher","DOI":"10.1186\/1865-1380-6-40"},{"key":"2025090501554053000_107.4.268.2","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.2003.014274"},{"key":"2025090501554053000_107.4.268.3","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1016\/S0140-6736(00)57035-4","article-title":"On certain SEPTIC\u00c6MIAS due to anaerobic organisms","volume":"227","author":"Lemierre","year":"1936","journal-title":"The Lancet"},{"key":"2025090501554053000_107.4.268.4","doi-asserted-by":"publisher","DOI":"10.2147\/IDR.S95050"},{"key":"2025090501554053000_107.4.268.5","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1097\/MBC.0b013e32832dc312","article-title":"Unusual presentation of Lemierre's syndrome: two cases and a review","volume":"20","author":"van Wissen","year":"2009","journal-title":"Blood Coagul Fibrinolysis"},{"key":"2025090501554053000_107.4.268.6","doi-asserted-by":"crossref","first-page":"S47","DOI":"10.1016\/S0163-4453(17)30191-3","article-title":"The long shadow of Lemierre's syndrome","volume":"74 Suppl 1","author":"Osowicki","year":"2017","journal-title":"J Infect"},{"key":"2025090501554053000_107.4.268.7","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20542"}],"container-title":["Archives of disease in childhood - Education & practice edition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/archdischild-2020-320122","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T08:59:36Z","timestamp":1757062776000},"score":1,"resource":{"primary":{"URL":"https:\/\/ep.bmj.com\/lookup\/doi\/10.1136\/archdischild-2020-320122"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,10]]},"references-count":7,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,7,19]]},"published-print":{"date-parts":[[2022,8]]}},"alternative-id":["10.1136\/archdischild-2020-320122"],"URL":"https:\/\/doi.org\/10.1136\/archdischild-2020-320122","relation":{},"ISSN":["1743-0585","1743-0593"],"issn-type":[{"type":"print","value":"1743-0585"},{"type":"electronic","value":"1743-0593"}],"subject":[],"published":{"date-parts":[[2020,11,10]]}}}