Author: Abdul Aziz, Dan Boden / Editor: Stephen Sheridan / Codes: / Published: 12/01/2026
A 39-year-old male presents with a 45-day history of general malaise, fever, rigors, and worsening shortness of breath. He reports mild chest discomfort and swelling in the left anterior neck.
The illness started with tonsillitis last week, for which his GP prescribed oral Amoxicillin. After starting antibiotics, he initially felt better, but then deteriorated.
The patient doesnt report any cough. His chest pain localizes to the central chest and feels like a burning sensation. He has no other significant past medical history.
On arrival, his observations show:
- Temperature 39.7 C
- Heart rate 140 bpm
- Blood pressure 88/50 mmHg
- SpO 91% on room air
On examination, he appears unwell. There is a 22 cm round, red, tender swelling in the left supraclavicular region near the base of the left sternocleidomastoid. Bilateral chest crepitations are audible on auscultation. Throat examination reveals left tonsillar enlargement with erythema.
Initial laboratory results reveal:
- WBC 25,000 with predominant neutrophilia
- CRP 350
- Mildly deranged liver function tests
- Renal function showing AKI stage 2
He has no history of drug allergies.
The ECG demonstrates sinus tachycardia with non-specific changes.
