A 46-Year-Old Smoker With Neck Swelling, Fever, and Delirium

Moatasem bellah Elshareif, MD


June 16, 2023

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A 46-year-old man presents to the emergency department (ED) with fever and left-sided neck swelling that extends to the anterior chest wall. He is drowsy and confused. The patient was transferred to the ED from a rural hospital. His past history reveals that he initially sought medical attention because of severe neck pain associated with fever and chills. He was given a painkiller but did not receive a clear diagnosis. The pain was not relieved, and the painful side of his neck was mildly swollen. The fever with chills persisted.

The patient has no history of trauma or injection to the neck or previous swelling. He has no history of chest tuberculosis. He reports no vomiting; however, he has dysphagia and refuses to eat. He has no other concerning symptoms. His medical history includes type 2 diabetes, for which he takes oral hypoglycemic medications. He also has chronic oral infection, with gingivitis and dental caries, especially of the molars. A heavy smoker, he has chronic bronchitis. He does not use illicit drugs or alcohol. No family history of malignant diseases is reported.


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