Penn State Milton S. Hershey Medical Center, USA
Kerlie Estimable completed her medical degree in April 2011 from the Ross University School of Medicine, and is currently a second year Family Medicine resident at the Penn State Milton S. Hershey Medical Center. She has a special interest in Primary Care Sports Medicine. She was a Provost Scholars Academic Achievement Awardee, a National Society of Collegiate Scholars member, a Golden Key International Honor Society member, and a Phi Sigma Theta National Honor Society member, while she was at the University of South Florida, where she graduated cum laude, majoringin Biomedical Sciences, with a minor in General Business Administration.
A 45-year-old male presented at the emergency room with severe neck pain and difficulty swallowing. Computed tomography (CT) showed a retropharyngeal soft tissue collection. Orthopedic Surgery was consulted as there was a defect in her C3 also seen. They felt that this was congenital and recommended Ears, Nose, Throat (ENT) consultation. The ENT service performed a fiberoptic scope which revealed a patent airway and no drainable abscess. The patient was admitted into the hospital and magnetic resonance imaging (MRI) of his neck was ordered. Past medical history revealed a history of severe hidradenitis suppurativa. The patient was in a Humira study for this. He did not know whether he was on the placebo or the Humira arm. On exam, he had decreased neck and jaw range of motion. His white blood cell count was elevated. The patient was started on Unasyn. The MRI showed findings consistent with acute calcific longus colli tendinitis. The Orthopedic Surgery service recommended intravenous steroids and inpatient Physical Therapy, then signed off. The Humira study primary investigator was on vacation at the time and the patient's study assignment could not be determined. Instead of steroids, Toradol was added which seemed to result with dramatic improvement. The patient was able to move his jaw and swallow slowly within 3 days. Toradol was switched to diclofenac sodium, and Unasyn was switched to Augmentin, then patient was discharged. On follow-up, the patient was tolerating a regular diet, and moving his neck and jaw without pain, even without medications.