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eMedicine Case
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Sore Throat and Ear Pain
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BACKGROUND
A 29-year-old man presents to the hospital with a sore throat and left ear pain that have lasted 5 days. He has a history of bipolar disorder and is taking lithium. He has had some dysphagia, fever to a maximum temperature of 102°F (38.9°C), and no ill contacts. He was treated at a different hospital and given a 5-day course of antibiotics, which he finished on the day of presentation. He has not been eating much because the pain is becoming worse. His current temperature is 99.7°F (37.6°C), and his other vital signs are stable. On examination, cervical lymphadenopathy, a marked left facial droop, and vesicles in his left ear are noted. The tympanic membrane is dull but not infested with vesicles. The patient has erythema and blisters on the left side of the tongue. What is the diagnosis, and how is it treated?
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Hint
The patient also complains that his left eye is dry and that vision in that eye is blurry. Physical examination reveals the following: pupils equal, round, and reactive to light (PERRL); extraocular movements intact (EOMI); no diplopia; and no obvious conjunctivitis or other external eye problems. The patient has a severe corneal abrasion from not being able to completely close his left eye. No dendrites are seen on fluorescein examination. Facial sensation is intact. Hint: Consider a possible syndrome.
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Author:
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Ernie Wang, MD
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eMedicine Editor:
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John Leung, MD
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Yale University- Yale New Haven Hospital
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