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Kumai T, Inoue T, Sakaue S, Ohara K, Takahara M. An Otogenic Variant of Lemierre's Syndrome Caused by Trueperella bernardiae: A Case Report and Literature Review. Cureus 2023; 15:e42977. [PMID: 37671227 PMCID: PMC10476011 DOI: 10.7759/cureus.42977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/07/2023] Open
Abstract
Upper airway infections caused by anaerobic bacteria, including pharyngitis and tonsillitis, are a common cause of septic thrombosis (Lemierre's syndrome). Although otitis media rarely progresses to systemic infection, an abscess surrounding the middle ear can affect the central nervous system. Trueperella bernardiae was originally considered a non-pathogenic aerobic bacterium but has subsequently been reported to cause bacteremia and brain abscesses. Here, we report a case of otitis media caused by T. bernardiae complicated by meningitis, subdural empyema, and septic pulmonary emboli in an immunocompetent patient.
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Affiliation(s)
- Takumi Kumai
- Department of Otolaryngology, Head and Neck Surgery, Asahikawa Medical University, Asahikawa, JPN
| | - Takahiro Inoue
- Department of Otolaryngology, Head and Neck Surgery, Asahikawa Medical University, Asahikawa, JPN
| | - Shota Sakaue
- Department of Otolaryngology, Head and Neck Surgery, Asahikawa Medical University, Asahikawa, JPN
| | - Kenzo Ohara
- Department of Otolaryngology, Head and Neck Surgery, Asahikawa Medical University, Asahikawa, JPN
| | - Miki Takahara
- Department of Otolaryngology, Head and Neck Surgery, Asahikawa Medical University, Asahikawa, JPN
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2
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Carballo Cuello C, De Jesus O, Labat EJ, Pastrana EA. Lemierre syndrome leading to an ischaemic stroke and malignant cerebral oedema. BMJ Case Rep 2021; 14:14/7/e243690. [PMID: 34253528 DOI: 10.1136/bcr-2021-243690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lemierre syndrome is an often misdiagnosed disease caused by an anaerobic bacterial infection that produces thrombophlebitis of the internal jugular vein and septic metastasis to distal organs, especially the lungs. Carotid stenosis or thrombosis is a rare complication. We present a patient with Lemierre syndrome who developed malignant cerebral oedema secondary to an ischaemic stroke which required a decompressive craniectomy.
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Affiliation(s)
- Cesar Carballo Cuello
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, Puerto Rico
| | - Orlando De Jesus
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, Puerto Rico
| | - Eduardo J Labat
- Department of Radiological Sciences and Diagnostic Radiology, Neuroradiology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, Puerto Rico
| | - Emil A Pastrana
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, Puerto Rico
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Bazzout A, Lachkar A, Benfadil D, El Ayoubi F, Abdenbi Tsen A, Ghailan R. An chronic otitis media with effusion complicated with paravertebral abscess: Case report and review of the literature. Int J Surg Case Rep 2021; 79:104-107. [PMID: 33450586 PMCID: PMC7806952 DOI: 10.1016/j.ijscr.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/01/2021] [Accepted: 01/01/2021] [Indexed: 11/18/2022] Open
Abstract
Chronic otitis media with effusion occurs post-radiotherapy can cause serious complication. Paravertebral abscess. No reported case of a paravertebral abscess post chronic otitis media with effusion. Our objective was to bring attention to chronic masked mastoiditis.
Introduction Chronic otitis media are still present and often overlooked. Our observation is interesting by the association of double purulent complications of chronic otitis media: paravertebral abscess and lateral sinus thrombosis. Case We report the case of a 54-year-old man with a long history of NPC, who presented to the hospital with severe right earache, associated with headache and 39°fever. CT scan and MRI assessed a complicated chronic otitis media of the middle ear by thrombophlebitis of the lateral sinus and posterior paravertebral abscess. He was put under antibiotic therapy and cortical mastoidectomy two weeks later. Nearly one-year follow up reveals a satisfactory recovery. Conclusion The chronic otitis media with effusion deserves careful monitoring. The early diagnosis and adequate treatment of this life-threatening lesion may result in excellent prognosis. Especially for young people in developing countries.
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Affiliation(s)
- Asmae Bazzout
- University Hospital Center Mohamed VI, Oujda, Morocco; Faculty of Medicine and Pharmacy, Oujda, Morocco.
| | - Azzeddine Lachkar
- University Hospital Center Mohamed VI, Oujda, Morocco; Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Drissia Benfadil
- University Hospital Center Mohamed VI, Oujda, Morocco; Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Fahd El Ayoubi
- University Hospital Center Mohamed VI, Oujda, Morocco; Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Adil Abdenbi Tsen
- University Hospital Center Mohamed VI, Oujda, Morocco; Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Rachid Ghailan
- University Hospital Center Mohamed VI, Oujda, Morocco; Faculty of Medicine and Pharmacy, Oujda, Morocco
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Ulanovski D, Shavit SS, Scheuerman O, Sokolov M, Hilly O, Raveh E. Medical and surgical characteristics of fusobacterium necrophorum mastoiditis in children. Int J Pediatr Otorhinolaryngol 2020; 138:110324. [PMID: 32911237 DOI: 10.1016/j.ijporl.2020.110324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/15/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate and compare characteristics of Fusobacterium necrophorum mastoiditis (FnM) to characteristics of acute mastoiditis (AM) caused by other bacteria in tertiary children hospital Methods : Children with FnM (N=43) and non FnM (N=88). Assess medical, microbiologic and imaging characteristics, surgical findings and postoperative recovery. RESULTS Children with FnM had a positive history of otitis media, ear discharge and sub-periosteal abscess (p=0.0004, 0.09, 0.0003, respectively) at presentation. Their temperature, WBC and CRP were significantly higher (39.8 vs. 37.9, 19.4K vs. 16.1K, 21 vs. 8.7, p=0.0001). Positive culture was found in 46% of patients; 64% were diagnosed by PCR. CT scan was indicated in 95% and surgical intervention in 93% of children with FnM, compared to 15% and 9.7% of children in the non-FnM group (p=0.0001). Complex post-operative course was frequent for the FnM group: 88% of children had persistent fever, 46% had additional imaging and 14% additional surgical intervention. Children with FnM were treated with IV antibiotics for an average of 22 compared to seven days for non-FnM children (p=0.0001). CONCLUSIONS Fusobacterium should be suspect in a child presenting with AM, a septic appearance, high fever and increased inflammation markers. A regimen of two antibiotics should be empirically started, then proceed to imaging and early surgical intervention. A relatively slow post-operative recovery process should be expected; however, prognosis is good.
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Affiliation(s)
- David Ulanovski
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sagit Stern Shavit
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Scheuerman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Meirav Sokolov
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Hilly
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eyal Raveh
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lee WS, Jean SS, Chen FL, Hsieh SM, Hsueh PR. Lemierre's syndrome: A forgotten and re-emerging infection. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 53:513-517. [PMID: 32303484 DOI: 10.1016/j.jmii.2020.03.027] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 01/08/2023]
Abstract
Lemierre's syndrome, also known as post-anginal septicemia or necrobacillosis, is characterized by bacteremia, internal jugular vein thrombophlebitis, and metastatic septic emboli secondary to acute pharyngeal infections. Modern physicians have "forgotten" this disease. The most common causative agent of Lemierre's syndrome is Fusobacterium necrophorum, followed by Fusobacterium nucleatum and anaerobic bacteria such as streptococci, staphylococci, and Klebsiella pneumoniae. The causative focus mostly originated from pharyngitis or tonsillitis, accounting for over 85% of the cases of Lemierre's syndrome. Pneumonia or pleural empyema is the most common metastatic infection in Lemierre's syndrome. Antimicrobial therapy should be prescribed for 3-6 weeks. The treatment regimens include metronidazole and β-lactam antibiotics. In recent years, the antibiotic stewardship program has resulted in decreased antibiotic prescription for upper respiratory tract infections. The incidence of Lemierre's syndrome has increased over the past decade. F. necrophorum is an underestimated cause of acute pharyngitis or tonsillitis. A high index of suspicion is required for the differential diagnosis of acute tonsillopharyngitis with persistent neck pain and septic syndrome.
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Affiliation(s)
- Wen-Sen Lee
- Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shio-Shin Jean
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Emergency Medicine, Department of Emergency and Critical Care Medicine, Wan Fang Medical Center, Taipei Medicine University, Taipei, Taiwan
| | - Fu-Lun Chen
- Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Szu-Min Hsieh
- Departments of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Po-Ren Hsueh
- Departments of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Olaf M, Duguet L. Mastoiditis with concomitant Lemierre's syndrome. Am J Emerg Med 2019; 37:1214.e1-1214.e3. [PMID: 30786966 DOI: 10.1016/j.ajem.2019.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022] Open
Abstract
Otalgia with mastoiditis is an infrequently encountered complication of acute otitis media (Pfaff and Moore, 2018). Even more rare is the development of infected jugular venous thrombosis, Lemierre's disease. We present a case of a six year-old girl with otalgia for over two months who presented to our Emergency Department (ED) with clinical mastoiditis, confirmed on CT scan, as well as an incidental diagnosis of complete thrombosis of the internal jugular (IJ) vein, Lemierre's syndrome. The true prevalence of Lemierre's from mastoiditis is difficult to discern. This clinical case highlights the importance of the consideration of these pathologies by the emergency physician.
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Affiliation(s)
- Mark Olaf
- Department of Emergency Medicine, Geisinger Health System, 100 North Academy Ave., Danville, PA 17822-2005, USA.
| | - Lindsey Duguet
- Department of Emergency Medicine, Geisinger Health System, 100 North Academy Ave., Danville, PA 17822-2005, USA
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Cox M, Epelman M, Chandra T, Meyers AB, Johnson CM, Podberesky DJ. Non–Catheter-related Venous Thromboembolism in Children: Imaging Review from Head to Toe. Radiographics 2017; 37:1753-1774. [DOI: 10.1148/rg.2017170036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Mougnyan Cox
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Monica Epelman
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Tushar Chandra
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Arthur B. Meyers
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Craig M. Johnson
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
| | - Daniel J. Podberesky
- From the Department of Medical Imaging, Nemours Children’s Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children’s Health System/Nemours Children’s Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.)
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Shamriz O, Engelhard D, Temper V, Revel-Vilk S, Benenson S, Brooks R, Tenenbaum A, Stepensky P, Koplewitz B, Kaufmann M, Averbuch D. Infections caused by Fusobacterium in children: a 14-year single-center experience. Infection 2015; 43:663-70. [PMID: 25929419 DOI: 10.1007/s15010-015-0782-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 04/16/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE This study aimed at reviewing our experience with infections caused by Fusobacterium in children. METHODS A retrospective analysis of medical records of children admitted to Hadassah-Hebrew University Medical Center from 2000 to 2013, in whom Fusobacterium spp. was identified in any specimen. RESULTS A total of 22 patients (males = 12) at a mean ± SE age of 5 ± 1 (range 1-17) years, were identified. The most common complication was abscess formation (n = 11, 50 %). Eight children (36.4 %) had intracranial complications, including brain abscess (n = 4), meningitis (n = 4) and cerebral sinus vein thrombosis (CSVT, n = 5). Seventeen children (77 %) had bacteremia. Primary site of infection was otogenic (n = 9), oropharyngeal (n = 7), respiratory (n = 2), sinuses (n = 2), intra-abdominal (n = 1) and mucositis (n = 1). Fourteen cases were caused by Fusobacterium necrophorum, including four cases with CSVT, 7/8 cases of mastoiditis, four of them with subperiosteal abscess formation; all four cases with meningitis and two brain abscesses. Fifteen (68 %) patients required surgical intervention and 3 (14 %) received anti-coagulation therapy. Excluding one patient with overwhelming sepsis with fatal outcome, all patients recovered. CONCLUSIONS Fusobacterium infections in children can cause a diverse spectrum of disease and is associated with high rates of abscess formation and intracranial complications. Although Fusobacterium nucleatum is abundant in the oral cavity, F. necrophorum is the main pathogen that causes severe infections in healthy children.
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Affiliation(s)
- Oded Shamriz
- Pediatric Division, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Dan Engelhard
- Pediatric Division, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel.,Pediatric Infectious Diseases Unit, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Violeta Temper
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Shoshana Revel-Vilk
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Shmuel Benenson
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Rebecca Brooks
- Pediatric Division, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Ariel Tenenbaum
- Pediatric Division, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Polina Stepensky
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Benjamin Koplewitz
- Department of Medical Imaging, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Michal Kaufmann
- Department of Otolaryngology/Head & Neck Surgery, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Diana Averbuch
- Pediatric Division, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel. .,Pediatric Infectious Diseases Unit, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel.
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Hagiya H, Haruki Y, Otsuka F. Lemierre syndrome involving external jugular vein. Acute Med Surg 2014; 2:64-68. [PMID: 29123694 DOI: 10.1002/ams2.61] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 05/20/2014] [Indexed: 11/06/2022] Open
Abstract
Case A 74-year-old woman with a week-long history of cold symptoms was diagnosed with Lemierre syndrome that involved her left external jugular vein. Outcome The patient was successfully treated with 4 weeks of antibiotics and anticoagulant treatment. Typical cases of Lemierre syndrome involve only the internal jugular vein. The external jugular vein is anatomically distant from the pharyngolaryngeal space and usually does not receive blood or lymphatic flow from there. Thus, Lemierre syndrome ordinarily does not involve the external jugular vein and clinical characteristics of external jugular vein-involving Lemierre syndrome have not been uncovered, mainly due to its rarity. Based on our review, it would not much differ from those of typical cases. Conclusion Considering the potential severity and mortality, more attention should be paid to this potentially fatal disease that may demonstrate atypical manifestation, as shown in this case. Accumulation of cases would be needed for further understanding.
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Affiliation(s)
- Hideharu Hagiya
- Department of General Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tsuyama Okayama Japan
| | - Yuto Haruki
- Department of Pharmacy Tsuyama Central Hospital Tsuyama Okayama Japan
| | - Fumio Otsuka
- Department of General Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tsuyama Okayama Japan
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Gupta T, Parikh K, Puri S, Agrawal S, Agrawal N, Sharma D, DeLorenzo L. The forgotten disease: Bilateral lemierre's disease with mycotic aneurysm of the vertebral artery. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:230-4. [PMID: 24883173 PMCID: PMC4038640 DOI: 10.12659/ajcr.890449] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 02/17/2014] [Indexed: 11/09/2022]
Abstract
Patient: Male, 25 Final Diagnosis: Lemierre’s disease Symptoms: Back pain • fever • headache • tachycardia • tachypnoe Medication: — Clinical Procedure: — Specialty: Infectious Diseases
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Affiliation(s)
- Tanush Gupta
- Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, U.S.A
| | - Kaushal Parikh
- Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, U.S.A
| | - Sonam Puri
- Department of Internal Medicine, University of Connecticut, Farmington, CT, U.S.A
| | - Sahil Agrawal
- Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, U.S.A
| | - Nikhil Agrawal
- Department of Internal Medicine, University of Florida, Gainesville, FL, U.S.A
| | - Divakar Sharma
- Department of Pulmonary and Critical Care, Westchester Medical Center, New York Medical College, Valhalla, NY, U.S.A
| | - Lawrence DeLorenzo
- Department of Pulmonary and Critical Care, Westchester Medical Center, New York Medical College, Valhalla, NY, U.S.A
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Aggarwal SK, Nath A, Singh R, Keshri A. Lemierre's Syndrome presenting with neurological and pulmonary symptoms: Case report and review of the literature. Ann Indian Acad Neurol 2013; 16:259-63. [PMID: 23956578 PMCID: PMC3724088 DOI: 10.4103/0972-2327.112489] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 01/26/2012] [Accepted: 02/19/2012] [Indexed: 11/22/2022] Open
Abstract
Lemierre’s Syndrome (LS) is a potentially life-threatening condition, characterized by clinical or radiologic evidence of internal jugular vein thrombosis following an oropharyngeal infection, most commonly by Fusobacterium necrophorum. A high index of suspicion and early recognition is important for successful management and to prevent systemic complications like multiorgan failure with extremely high morbidity, prolonged hospitalization and, not uncommonly, death. We are reporting a rare case of LS that was complicated with internal jugular vein and cavernous sinus thrombosis along with lung metastatic lesions, which was diagnosed and treated at our institute.
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Affiliation(s)
- Sushil Kumar Aggarwal
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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12
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Kuppalli K, Livorsi D, Talati NJ, Osborn M. Lemierre's syndrome due to Fusobacterium necrophorum. THE LANCET. INFECTIOUS DISEASES 2012; 12:808-15. [PMID: 22633566 DOI: 10.1016/s1473-3099(12)70089-0] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We present a case of a patient with Lemierre's syndrome caused by Fusobacterium necrophorum who developed a right frontal lobe brain abscess. We summarise the epidemiology, microbiology, pathogenesis, clinical presentation, diagnosis, complications, therapy, and outcomes of Lemierre's syndrome. F necrophorum is most commonly associated with Lemierre's syndrome: a septic thrombophlebitis of the internal jugular vein. Patients usually present with an exudative tonsillitis, sore throat, dysphagia, and unilateral neck pain. Diagnosis of septic thrombophlebitis is best confirmed by obtaining a CT scan of the neck with contrast. Complications of the disease include bacteraemia with septic abscesses to the lungs, joints, liver, peritoneum, kidneys, and brain. Treatment should include a prolonged course of intravenous beta-lactam antibiotic plus metronidazole.
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Affiliation(s)
- Krutika Kuppalli
- Department of Medicine, Division of Infectious Diseases, Division of Global Public Health, University of California, San Diego, San Diego, CA 92103-8208, USA.
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Courtin P, Toro A, Gazagnes M, Berrouba A, Gallardo M, Dembele A. [Lemierre's syndrome]. ACTA ACUST UNITED AC 2010; 29:799-802. [PMID: 21035996 DOI: 10.1016/j.annfar.2010.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 07/30/2010] [Indexed: 10/18/2022]
Abstract
Lemierre's syndrome is a rare disease, mostly affecting young adults in good health, which can lead to significant morbidity and mortality. We report one case with favourable outcome and clinical features stereotypics: angina, septic thrombosis of the internal jugular vein, pulmonary septic metastasis, Fusobacterium necrophorum on blood cultures. Antibiotic therapy targeting anaerobes has been rapidly initiated and maintained 4-6 weeks. The anticoagulation has been maintained 4 weeks.
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Affiliation(s)
- P Courtin
- Service de réanimation, centre hospitalier de Martigues, 3, boulevard des Rayettes, BP 50248, 13698 Martigues cedex, France.
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Affiliation(s)
- Walter Dehority
- Department of Pediatrics, University of California, San Diego School of Medicine, San Diego, California, USA.
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Fusobacterium necrophorum middle ear infections in children and related complications: report of 25 cases and literature review. Pediatr Infect Dis J 2008; 27:613-7. [PMID: 18520974 DOI: 10.1097/inf.0b013e318169035e] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fusobacterium necrophorum is associated with Lemierre syndrome (pharyngitis with septic thrombosis of the internal jugular veins) but it can also be involved in other head and neck infections, including sinusitis, parotitis, dental infections, and otitis media. METHODS This retrospective study analyzes a series of 25 pediatric cases of acute otitis media caused by F. necrophorum and treated in our institution between 1995 and 2006. RESULTS We observed 3 clinical presentations: (1) uncomplicated otitis media (44%; n = 11); (2) acute mastoiditis (40%; n = 10); and (3) otogenic variant of Lemierre syndrome (16%; n = 4) associating acute mastoiditis, suppurative thrombophlebitis of the lateral and/or cavernous sinuses, meningitis syndrome, and sometimes distant septic metastasis or extensive osteolysis of the temporal bone. Sixty percent of these cases were diagnosed during the last 4 years of the study. Children less than 1 year of age were at increased risk for Lemierre syndrome. Broad range 16S rDNA polymerase chain reaction and sequencing were used to confirm the identification of F. necrophroum and to detect secondary sites of infection. All patients had favorable clinical outcome, but complicated cases (mastoiditis and otogenic variant of Lemierre syndrome) required prolonged hospital stays and duration of treatment. CONCLUSIONS Based on bacteriologic investigation, we recommend systematic culture for anaerobes and that antibiotic treatment of F. necrophorum middle ear infections and subsequent complications includes coverage for anaerobic bacteria.
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Redaelli de Zinis LO, Gasparotti R, Campovecchi C, Annibale G, Barezzani MG. Internal jugular vein thrombosis associated with acute mastoiditis in a pediatric age. Otol Neurotol 2008; 27:937-44. [PMID: 17006344 DOI: 10.1097/01.mao.0000226314.20188.8a] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To discuss the clinical aspects and management of internal jugular vein thrombosis associated with acute otitis media. STUDY DESIGN Case reports and review of the literature. SETTING University hospital, tertiary referral center. PATIENT The authors describe two cases of internal jugular vein thrombosis, without sigmoid sinus thrombosis, secondary to acute otomastoiditis. INTERVENTION Jugular vein thrombosis was diagnosed in both cases by observation of filling defects of the involved jugular bulb on contrast-enhanced computed tomography and confirmed by conventional magnetic resonance and magnetic resonance venography. RESULTS Both patients recovered after recanalization of the vessel concomitant to anticoagulation and antibiotic treatment associated with a simple mastoidectomy. CONCLUSION Internal jugular vein thrombosis may be a complication of acute otitis media, without involvement of the sigmoid sinus and with a starting point in the jugular bulb. Anticoagulation associated with antibiotic therapy can be considered a safe and effective treatment. Surgery should only be performed to eliminate the source of infection from the middle ear and mastoid.
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Riordan T. Human infection with Fusobacterium necrophorum (Necrobacillosis), with a focus on Lemierre's syndrome. Clin Microbiol Rev 2007; 20:622-59. [PMID: 17934077 PMCID: PMC2176048 DOI: 10.1128/cmr.00011-07] [Citation(s) in RCA: 360] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Human infection with Fusobacterium necrophorum usually involves F. necrophorum subsp. funduliforme rather than F. necrophorum subsp. necrophorum, which is a common pathogen in animals. Lemierre's syndrome, or postanginal sepsis, is the most common life-threatening manifestation. Tonsillitis is followed by septic thrombophlebitis of the internal jugular vein and then a septicemia with septic emboli in lungs and other sites. Recent evidence suggests that F. necrophorum can be limited to the throat and cause persistent or recurrent tonsillitis. F. necrophorum is unique among non-spore-forming anaerobes, first for its virulence and association with Lemierre's syndrome as a monomicrobial infection and second because it seems probable that it is an exogenously acquired infection. The source of infection is unclear; suggestions include acquisition from animals or human-to-human transmission. Approximately 10% of published cases are associated with infectious mononucleosis, which may facilitate invasion. Recent work suggests that underlying thrombophilia may predispose to internal jugular vein thrombophlebitis. Lemierre's syndrome was relatively common in the preantibiotic era but seemed to virtually disappear with widespread use of antibiotics for upper respiratory tract infection. In the last 15 years there has been a rise in incidence, possibly related to restriction in antibiotic use for sore throat.
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Affiliation(s)
- Terry Riordan
- Microbiology Department, Royal Devon & Exeter Foundation Trust, Exeter, United Kingdom.
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Abstract
Lemierre syndrome is a rare disease that's characterized by internal jugular vein thrombosis and septic emboli. These symptoms typically develop after acute oropharyngeal infection by Fusobacterium necrophorum. Although this syndrome is less frequently seen in modern times due to the availability of antibiotics, physicians must be aware of the syndrome in order to initiate prompt antibiotics therapy, including coverage of the anerobic organisms. We discuss here the case of an 18-year-old female with Lemierre syndrome and we review the relevant literature on this syndrome.
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Affiliation(s)
- Young Tak Seo
- Department of Internal Medicine, Hong-ik Hospital, Seoul, Korea
| | - Mi Jin Kim
- Department of Internal Medicine, Hong-ik Hospital, Seoul, Korea
| | - Ji Hoon Kim
- Department of Internal Medicine, Hong-ik Hospital, Seoul, Korea
| | - Byung Wook Ha
- Department of Internal Medicine, Hong-ik Hospital, Seoul, Korea
| | - Hyo Sun Choi
- Department of Radiology, Hong-ik Hospital, Seoul, Korea
| | - Yong Tai Kim
- Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Gyonggido, Korea
| | - Young Hwan Ham
- Department of Internal Medicine, Hong-ik Hospital, Seoul, Korea
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Fariñas Salto M, Santos Sebastián MM, Gutiérrez Triguero M, Rodríguez Fernández R. Mastoiditis por Fusobacterium necrophorum. An Pediatr (Barc) 2007; 66:193-4. [PMID: 17306110 DOI: 10.1016/s1695-4033(07)70333-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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20
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Shibasaki Warabi Y, Yoshikawa H, Idezuka J, Yamazaki M, Onishi Y. Cerebral infarctions and brain abscess due to Lemierre syndrome. Intern Med 2005; 44:653-6. [PMID: 16020900 DOI: 10.2169/internalmedicine.44.653] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Lemierre syndrome is characterized by anaerobic bacterial infection in the head and neck, causing thrombophlebitis of the jugular vein and septic metastasis to various distant organs, most often the lungs. Here we describe previously unreported clinical features of cerebral infarctions and brain abscess due to metastatic septic embolism of this uncommon but lethal syndrome, and the successful course of treatment with ampicillin, cefotaxime and metronidazole.
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22
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Masterson T, El-Hakim H, Magnus K, Robinson J. A case of the otogenic variant of Lemierre's syndrome with atypical sequelae and a review of pediatric literature. Int J Pediatr Otorhinolaryngol 2005; 69:117-22. [PMID: 15627459 DOI: 10.1016/j.ijporl.2004.07.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2004] [Revised: 07/24/2004] [Accepted: 07/25/2004] [Indexed: 11/24/2022]
Abstract
We report a case of an 8-year-old girl who presented with the clinical picture of Lemierre's syndrome (LS) secondary to bilateral mastoiditis. She developed unilateral sensorineural hearing loss (SNHL) along with internal jugular vein (IJV) thrombosis, septic arthritis of her ankle and cervical fasciitis. Combined antimicrobial, anticoagulant and surgical treatment helped reverse all the effects of the sequelae, including nearly all the hearing loss. This is a unique case of this uncommon variant of the syndrome and with an uncommonly reported complication. The literature indicates that pediatric cases are a minority and enforces that successful management rests on awareness of the condition, vigil and promptness of communication of a multidisciplinary pediatric team.
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Affiliation(s)
- Tami Masterson
- Department of Pediatrics, The Stollery Children's Hospital, Edmonton, Alta., Canada
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23
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Litterio MR, Soto AE, Aguirre CB, Uranga M, Rubeglio E. Lemierre's syndrome: case report in a pediatric patient. Anaerobe 2004; 10:151-4. [PMID: 16701512 DOI: 10.1016/j.anaerobe.2004.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2002] [Revised: 03/10/2004] [Accepted: 03/10/2004] [Indexed: 11/22/2022]
Abstract
Lemierre's syndrome was described in 1936 as a severe oropharyngeal infection followed by septic thrombophlebitis of the internal jugular vein and disseminated metastatic infections. Cases occur typically in previously healthy young adults and children. Fusobacterium necrophorum is the main anaerobic bacterium implicated. We present a septic 2-month-old infant with mastoiditis, multiple sites of osteoarthritis and multiple subcutaneous abscesses. No underlying anatomic or immunologic abnormalities were identified. Fusobacterium necrophorum was recovered from blood and bone samples obtained intraoperatively. Treatment included anaerobic coverage and drainage of septic foci. The patient was discharged home on 35th hospital day with oral amoxicillin-clavulanic acid and he recovered without sequelae. This was the first case of Lemierre's syndrome in our hospital. We want to highlight the absence of jugular vein thrombophlebitis, the presence of mastoiditis as previous infection and the surprising appearance of this infection in an edentulous 2-month-old infant.
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Affiliation(s)
- M R Litterio
- Servicio de Microbiología, Hospital Nacional de Pediatría Dr Prof.J.P.Garrahan, Combate de los Pozos 1881 (C1425AAM), Buenos Aires, Argentina.
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Gormus N, Durgut K, Ozergin U, Odev K, Solak H. Lemierre's Syndrome Associated with Septic Pulmonary Embolism: A Case Report. Ann Vasc Surg 2004; 18:243-5. [PMID: 15253264 DOI: 10.1007/s10016-003-0089-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
An 18-year-old female patient suffering from a painful right-sided neck mass was admitted to our emergency service. Computed tomography of the neck revealed thrombosis of the right internal jugular vein. Computed tomography of the chest indicated septic pulmonary emboli in both lungs. Blood and oropharyngeal cultures showed proteus that was sensitive to cefepime and amicasin. Chemotherapy was administered for 12 days, however, her complaints continued with fulminant progression. An urgent decompression and excessive debridement were performed. Although Lemierre syndrome is a well-known cause of internal jugular vein thrombosis, association with proteus culture is very rare.
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Affiliation(s)
- Niyazi Gormus
- Department of Cardiovascular Surgery, Meram Medical School of Selcuk University, Konya, Turkey.
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25
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Ramirez S, Hild TG, Rudolph CN, Sty JR, Kehl SC, Havens P, Henrickson K, Chusid MJ. Increased diagnosis of Lemierre syndrome and other Fusobacterium necrophorum infections at a Children's Hospital. Pediatrics 2003; 112:e380. [PMID: 14595080 DOI: 10.1542/peds.112.5.e380] [Citation(s) in RCA: 165] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the apparent increase in the diagnosis of Lemierre syndrome (LS) and other Fusobacterium necrophorum infections at a large children's hospital. Infections with F necrophorum ranged from peritonsillar abscess to potentially fatal LS. LS is an oropharyngeal infection characterized by septic thrombophlebitis of head and neck veins, complicated by dissemination of septic emboli to pulmonary and systemic sites. METHODS Review of the medical and laboratory records was conducted of all patients who were seen at or admitted to the Children's Hospital of Wisconsin with the diagnosis of LS and/or isolation of F necrophorum from a clinical specimen between January 1995 and January 2002. RESULTS During the 7-year period of the study, there was an increase in the isolation of F necrophorum from patients who were seen at Children's Hospital of Wisconsin, as well as the number of cases of LS. There was 1 isolation of F necrophorum from clinical specimens per year from 1996 to 1999, which increased to 10 isolates of the organism from January 2000 to January 2002. During the most recent period, January 2001-January 2002, 5 cases of LS were diagnosed, a distinctive entity not recognized previously at the institution. CONCLUSIONS The cause for the recent increase in the number of serious infections caused by F necrophorum infection diagnosed at our institution is unclear but does not seem to be related to changes in microbiologic techniques or patient demography. We speculate that it could be attributable, in part, to alterations in antibiotic usage patterns in our region. Clinicians need to be aware of the increasing clinical importance of F necrophorum infections and the life-threatening nature of LS.
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Affiliation(s)
- Susan Ramirez
- Department of Internal Medicine, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee 53226, USA
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Abstract
Lemierre's syndrome (LS) typically occurs in previously healthy young adolescents and young adults who become acutely ill following an attack of pharyngotonsillitis. Also known as post anginal sepsis, those afflicted develop pyrexia, rigours and multiple metastatic abscesses that lead to septic thrombophlebitis of the internal jugular vein. In the pre-antibiotic era this particularly virulent syndrome had a mortality rate in excess of 90%, but since the introduction of antibiotics and the widespread treatment of throat infections, it has became almost unknown. However, due to a number of factors, including a reduction in the use of antibiotics for the treatment of sore throats, misdiagnosis and/or improvements in microbiology diagnostic techniques, several reports have indicated a resurgence of the condition. This has major ramifications for critical care nurses as LS is still associated with significant morbidity and mortality. This paper discusses the aetiology, pathophysiology, bacteriology, diagnosis and management aspects of this syndrome. A case study of a young woman is presented to illustrate the complexity of the condition, and highlight how early diagnosis and prompt initiation of appropriate intravenous antibiotic therapy ensured a favourable clinical outcome.
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Abstract
Lemierre's syndrome is a rare but potentially life-threatening entity that follows an oropharyngeal infection. The syndrome is characterized by an antecedent acute oropharyngeal infection, with secondary suppurative thrombophlebitis of the internal jugular vein and septic emboli. In the pre-antibiotic era, it had a 90% mortality rate. Now, with the advent of antibiotics, the prognosis is favorable, but delays in diagnosis may result in increased morbidity and mortality. Its incidence appears to be increasing. We present a case of Lemierre's syndrome, most notable for the patient's essentially benign physical examination and lack of clinical improvement with penicillin.
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Affiliation(s)
- Marek Ma
- University Hospital, Cincinnati, Ohio 45267-0769, USA.
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28
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Abstract
UNLABELLED Lemierre syndrome is a severe postanginal sepsis complicated by internal jugular thrombophlebitis. We report on a 14 y-old girl affected by high fever, shivering chills, headache, severe lateral neck pain, left ocular proptosis and general malaise. Magnetic resonance imaging of the head and neck showed right internal jugular vein and sigmoid sinus thrombosis. Fusobacterium sp. was identified in the blood culture. CONCLUSION Our report is a reminder that Lemierre syndrome still exists and remains potentially life threatening. A high index of suspicion is necessary to prompt diagnosis and treatment.
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Affiliation(s)
- C Figueras Nadal
- Paediatric Infectious Diseases Section, Vall d'Hebron Hospital, Barcelona, Spain.
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29
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Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ. The evolution of Lemierre syndrome: report of 2 cases and review of the literature. Medicine (Baltimore) 2002; 81:458-65. [PMID: 12441902 DOI: 10.1097/00005792-200211000-00006] [Citation(s) in RCA: 262] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Lemierre syndrome (postanginal septicemia) is caused by an acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein and frequent metastatic infections. A high degree of clinical suspicion is necessary for diagnosis. Fusobacterium necrophorum is the usual etiologic agent. The disease progresses in several steps. The first stage is the primary infection, which is usually a pharyngitis (87.1% of cases). This is followed by local invasion of the lateral pharyngeal space and IJV septic thrombophlebitis (documented in 71.5% of cases), and finally, the occurrence of metastatic complications (present in 90% of cases at the time of diagnosis). A sore throat is the most common symptom during the primary infection (82.5% of cases). During invasion of the lateral pharyngeal space and IJV septic thrombophlebitis, a swollen and/or tender neck is the most common finding (52.2% of patients) and should be considered a red flag in patients with current or recent pharyngitis. The most common site of metastatic infection is the lungs (79.8% of cases). In contrast to the preantibiotic era, cavitating pneumonia and septic arthritis are now uncommon. Most patients (82.5%) had fever at some stage during the course of the disease. Gastrointestinal complaints such as abdominal pain, nausea, and vomiting were common (49.5% of cases). An elevated white blood cell count occurred in 75.2% of cases. Hyperbilirubinemia with slight elevation of liver enzyme levels occurred in one-third of patients, but frank jaundice was uncommon, in contrast to its high frequency reported in the preantibiotic era. We conclude that, most likely as a consequence of widespread antibiotic use for pharyngeal infections, the typical course of the disease has changed since Lemierre's original description. The typical triad in our series was: pharyngitis, a tender/swollen neck, and noncavitating pulmonary infiltrates. The previous classical description of severe sepsis with cavitating pneumonia and septic arthritis was not commonly seen in our review. Mortality was low in our series (6.4%), but significant morbidity occurred, which was likely preventable by early diagnosis and treatment. The pathophysiology, natural history, diagnostic methods for internal jugular vein thrombosis, and management are discussed.
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Affiliation(s)
- Julio A Chirinos
- Department of Medicine, University of Miami School of Medicine, FL, USA
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Fong SM, Watson M. Lemierre syndrome due to non-multiresistant methicillin-resistant Staphylococcus aureus. J Paediatr Child Health 2002; 38:305-7. [PMID: 12047702 DOI: 10.1046/j.1440-1754.2002.00784.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- S M Fong
- Department of Immunology and Infectious Diseases, Children's Hospital at Westmead,Westmead, New South Wales, Australia
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Moore BA, Dekle C, Werkhaven J. Bilateral Lemierre's Syndrome: A Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2002. [DOI: 10.1177/014556130208100412] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lemierre's syndrome is characterized by thrombosis of the internal jugular vein that develops following an oropharyngeal infection. Sepsis and septic metastases frequently ensue and affect the lungs, the musculoskeletal system, and occasionally the liver. Most cases are caused by infection with Fusobacterium necrophorum. This infection responds to antibiotic therapy with beta-lactamase-resistant compounds that exert good anaerobic coverage. Anticoagulation and surgical intervention can be helpful in advanced cases. Fewer than 160 cases of classic Lemierre's syndrome have been described; approximately one-third of these reported cases have occurred since 1988. We describe a new case of Lemierre's syndrome that occurred in an otherwise healthy 27-year-old man. Thrombosis of both internal jugular veins extended through the subclavian system and into both upper extremities. The patient was treated with intravenous antibiotics and heparin during 14 days of hospitalization. He was discharged on oral clindamycin and warfarin sodium, and after 6 months he was able to return to full activity. To our knowledge, this is the first reported case of Lemierre's syndrome in which internal jugular vein thrombosis occurred bilaterally. By reporting this previously undescribed manifestation of Lemierre's syndrome, we hope to increase practitioner awareness of this disease entity.
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Affiliation(s)
- Brian A. Moore
- Department of Otolaryngology-Head and Neck Surgery, the Vanderbilt Bill Wilkerson Center for Otolaryngology and Communication Sciences, Nashville, Tenn
| | - Catherine Dekle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Jay Werkhaven
- Department of Otolaryngology-Head and Neck Surgery, the Vanderbilt Bill Wilkerson Center for Otolaryngology and Communication Sciences, Nashville, Tenn
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Haibach P. Lemierre’s Syndrome in a Young Adult. Lab Med 2002. [DOI: 10.1309/helq-ammu-3h9w-2t3g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Sanz Gonzalo JJ, Alobid I, Martínez Molina P, Arias Cuchí G, Ruiz A, Cuchí A. [Jugular vein thrombosis: report of six cases]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2001; 52:432-6. [PMID: 11526652 DOI: 10.1016/s0001-6519(01)78232-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Venous thrombosis in superior extremities and neck represent less than 5% of the total of venous thrombosis. Internal jugular vein thrombosis is associated with intravenous drug abuse, long term venous catheterization, local infection or spontaneous occlusion. The clinical findings are cervical swelling, progressive inflammatory signs overlying sternomastoid muscle, and an important functional limitation. Diagnosis is confirmed by cervical ultrasounds and contrast-enhanced computer tomography. Usual treatment involves anticoagulation and antibiotics, surgery is not frequently needed. We described the management and outcome of six cases of internal jugular vein thrombosis.
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Rodríguez J, Fernández J, García MJ, Borque C, del Castillo F. [Mastoidal infection due to Fusobacterium necrophorum in children. Report of two cases]. Enferm Infecc Microbiol Clin 2001; 19:241-2. [PMID: 11446920 DOI: 10.1016/s0213-005x(01)72626-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Lemierre's syndrome is characterized by an oropharyngeal infection followed by internal jugular vein septic thrombophlebitis and metastatic emboli, most often to the lungs and joints. The syndrome is most commonly associated with the anaerobic gram-negative rod Fusobacterium necrophorum. Diagnosis is established with evidence of metastatic infection and internal jugular vein thrombophlebitis. CT is considered the diagnostic procedure of choice. Treatment should include an extended course of a beta-lactamase-resistant antibiotic and surgical drainage of any purulent fluid collection. Anticoagulation remains controversial, and ligation of the internal jugular vein is reserved for patients with persistent sepsis and recurrent emboli. With appropriate therapy, mortality is 4% to 12%; but mortality is increased when therapy is delayed.
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