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Xu Y, Shi Q, Ying H. Lemierre's syndrome complicating deep neck abscess: a case report. Thromb J 2023; 21:97. [PMID: 37715238 PMCID: PMC10504738 DOI: 10.1186/s12959-023-00543-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/10/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Lemierre's Syndrome is a severe medical condition that can result from oropharyngeal infection, typically caused by Fusobacterium necrophorum, leading to sepsis, internal jugular vein thrombosis, and metastatic septic emboli. However, there is limited literature on this syndrome caused by Streptococcus anginosus, and few previous cases have been reported to have deep neck space infection. We present the first case of Lemierre's Syndrome caused by Streptococcus anginosus with deep neck abscess. CASE PRESENTATION A 53-year-old male patient with no significant medical history presented with right neck pain after accidentally swallowing a fish bone one month ago. Laryngoscopy did not reveal any abnormalities. Five days prior to admission, the patient developed high fever. Imaging studies showed internal jugular vein thrombosis and a neck abscess surrounding the carotid artery sheath. Blood culture results were positive for Streptococcus anginosus infection, and the patient was diagnosed with Lemierre's syndrome. The patient underwent surgical drainage and received antibiotics and anticoagulant therapy, and had satisfactory clinical progress. He was discharged after a 16-day hospitalization. CONCLUSIONS Although Lemierre's syndrome is rare, it needs attention because it can lead to serious complications and requires timely treatment. Deep neck space infections can be life-threatening and doctors must be aware of its potential severity.
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Affiliation(s)
- Yi Xu
- Department of Otolaryngology, Ningbo No.2 Hospital, Ningbo, 315000, Zhejiang, China.
| | - Qingyuan Shi
- Department of Otolaryngology, Ningbo No.2 Hospital, Ningbo, 315000, Zhejiang, China
| | - Haiyue Ying
- Department of Otolaryngology, Ningbo No.2 Hospital, Ningbo, 315000, Zhejiang, China
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Nur Iyow S, Uzel M, Ibrahim IG, Artan Abdi A, Farah Yusuf Mohamud M. Lemierre Syndrome: Incidental Finding of Forgotten Fatal Disease as a Complication of Ludwig's Angina. Open Access Emerg Med 2023; 15:259-263. [PMID: 37502097 PMCID: PMC10370408 DOI: 10.2147/oaem.s408470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023] Open
Abstract
Lemierre syndrome (LS) is a rare, life-threatening complication of oropharyngeal infections associated with septicemia and internal jugular thrombosis. Internal jugular vein thrombosis is an uncommon disease associated with central vein catheterization, intravenous drug abuse, hypercoagulability, trauma to the neck, infection, ovarian hyperstimulation syndrome (OHSS), and systemic infections. Here, we highlight a case of a 62-year-old women who presented progressively worsening neck swelling for three weeks, shortness of breath, and fever for four days. Her sepsis due to Ludwig's angina was accompanied by septic pulmonary embolism and internal jugular vein thrombosis in keeping with a diagnosis of Lemierre syndrome. For this presentation of Lemierre syndrome, the treating physicians recommended surgical excision and drainage, followed by intravenous antibiotics and subcutaneous anticoagulation to treat septic emboli of the lungs and internal jugular veins. Sadly, after being informed about the procedure, the patient refused to consent, and four days later, she passed away. It is essential to remember that early detection and aggressive treatment may significantly impact prognosis and outcome.
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Affiliation(s)
- Sowdo Nur Iyow
- Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Muzeyyen Uzel
- Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
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3
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Silverberg B, Sharon MJ, Makati D, Mott M, Rose WD. Forget-me-not: Lemierre's syndrome, a case report. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:343-347. [PMID: 33760711 DOI: 10.1080/07448481.2021.1899190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/12/2021] [Accepted: 02/28/2021] [Indexed: 06/12/2023]
Abstract
Background: Familiarity breeds complacency. One case of sore throat can start to sound like another. However, even common viral and bacterial infections can lead to serious sequelae. Clinicians cannot make a diagnosis if they do not consider it in their differential.Case: The presentation - and subsequent hospitalization - of a septic 19 year-old male college student is described. Despite brief interval improvement, he became hypoxic one week after developing a sore throat and was ultimately diagnosed with Lemierre's syndrome (septic thrombophlebitis of the internal jugular vein) via blood cultures and advanced imaging.Conclusions: Though rare, Lemierre's syndrome carries a high mortality rate. It should be considered an emergent complication of head and neck infections, particularly in young adults.
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Affiliation(s)
- Benjamin Silverberg
- Division of Ambulatory Care, Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Melinda J Sharon
- Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Devan Makati
- Section of Nephrology, Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Mariah Mott
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - William D Rose
- Division of Ambulatory Care, Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
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4
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Linares CA, Ryan F, Hajat I, Glass S. Lemierre's syndrome involving milleri group streptococci: further insight into age and aetiology. BMJ Case Rep 2020; 13:13/11/e238062. [PMID: 33229487 DOI: 10.1136/bcr-2020-238062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Lemierre's syndrome (LS) is a suppurative thrombophlebitis of the internal jugular vein secondary to otorhinolaryngologic infection. It is classically associated with the Gram-negative anaerobe Fusobacterium necrophorum (FN) and is thought to be a disease of young people. Here, we describe the case of a 56-year-old woman with LS involving milleri group streptococci (MGS), which has been reported only 13 times since it was first observed in 2003. Subgroup analysis of all published cases of LS involving MGS demonstrated these patients were significantly older than those involving FN (median age 49 years versus 18 years, p = 0.007, IQR 36-58 years), although this finding is limited by publication bias. This report clarifies a 2014 hypothesis regarding the relationship between age and aetiology in this rare disease. While FN remains the most common cause of LS overall, empiric antibiotic therapy should also cover oral streptococci such as MGS, even in younger adults.
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Affiliation(s)
- Christian A Linares
- Medical Microbiology Service, East Kent Hospitals University NHS Foundation Trust, Ashford, Kent, UK
| | - Felicity Ryan
- Medical Microbiology Service, East Kent Hospitals University NHS Foundation Trust, Ashford, Kent, UK
| | - Imran Hajat
- Otolaryngology Department, East Kent Hospitals University NHS Foundation Trust, Ashford, Kent, UK
| | - Stephen Glass
- Medical Microbiology Service, East Kent Hospitals University NHS Foundation Trust, Ashford, Kent, UK
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Lanfear AT, Hamandi M, Fan J, Bolin ML, Williams M, DiMaio JM, Waters J. Lemierre's syndrome treated operatively. Proc AMIA Symp 2020; 33:671-673. [PMID: 33100566 DOI: 10.1080/08998280.2020.1772011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Lemierre's syndrome (LS) is a pharyngeal infection complicated by infectious jugular vein thrombosis and septic emboli. Most commonly caused by Fusobacterium necrophorum, it may result in metastatic infection, especially when antibiotic treatment is delayed. Patients with LS are often healthy adults between 16 and 30 years who present with prolonged symptoms of pharyngitis, lateral neck pain, and fever. Other symptoms may include shortness of breath, tachycardia, and hypotension. When administered promptly, antibiotics can act as an effective treatment. However, complications may arise that require additional intervention. Herein, we report a case of LS in a young adult, complicated by severe pleural effusions that required surgical decortication.
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Affiliation(s)
| | | | - Joy Fan
- Baylor Scott and White-The Heart Hospital, Plano, Texas
| | | | | | | | - John Waters
- Baylor Scott and White-The Heart Hospital, Plano, Texas
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De Smet K, Claus PE, Alliet G, Simpelaere A, Desmet G. Lemierre's syndrome: a case study with a short review of literature. Acta Clin Belg 2019; 74:206-210. [PMID: 29783881 DOI: 10.1080/17843286.2018.1474614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE AND IMPORTANCE Lemierre's syndrome (LS) is a rare condition that typically starts with a bacterial oropharyngeal infection complicated by a thrombophlebitis of the internal jugular vein and septic emboli to the lungs or other organs. The most common organism isolated is Fusobacterium necrophorum, although other causative organisms are isolated in rare cases. CASE PRESENTATION We discuss a case of LS in a 44-year-old, previously healthy man presenting with an oropharyngeal infection. F. necrophorum was isolated from blood cultures and Computed tomography of the chest demonstrated septic emboli in the lungs. Magnetic resonance imaging showed a thrombophlebitis of the sigmoid and transverse vein with continuity to the internal jugular vein. METHODS Case report and literature review. RESULTS F. necrophorum isolates show in vitro susceptibility to metronidazole, clindamycin, beta-lactam/beta-lactamase inhibitor combinations and carbapenems with no signs of resistance or reduced sensitivity. Anticoagulation is believed to play a favourable role in recovery of the disease because of the potential for faster resolution of thrombophlebitis and bacteraemia. Conflicting results exist in literature with many studies or reviews indicating a favourable outcome both with and without anticoagulation. Anticoagulation for LS consists in most cases of Warfarin or Low molecular weight heparins, with the last being the first choice in children. Indications for the use of anticoagulation in literature are significant clot burden, complication of septic emboli, arterial ischemic stroke, poor response to antibiotics, thrombophilia and cerebral infarction. CONCLUSIONS Antibiotics are considered the mainstay of treatment, although statistically valid trials to evaluate optimal treatment regimens have not yet been conducted due to the low incidence of the infection. The use of anticoagulation in LS is still heavily debated as a result of conflicting results in literature. Due to the disease's low incidence, statistically valid trials that evaluate anticoagulation are lacking. Further prospective and randomized research is needed to establish the benefit of anticoagulation in the treatment of LS.
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Affiliation(s)
- Ken De Smet
- Department of Pneumology, AZ Damiaan, Ostend, Belgium
| | - Paul-Emile Claus
- Clinical Laboratory of Microbiology, AZ Damiaan, Ostend, Belgium
| | - Gudrun Alliet
- Clinical Laboratory of Microbiology, AZ Damiaan, Ostend, Belgium
| | - An Simpelaere
- Department of Pneumology, AZ Damiaan, Ostend, Belgium
| | - Geert Desmet
- Department of Pneumology, AZ Damiaan, Ostend, Belgium
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7
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Greydanus DE, Merrick J. Infectious mononucleosis: be aware of its lethality! Int J Adolesc Med Health 2019; 31:ijamh-2018-0284. [PMID: 30645196 DOI: 10.1515/ijamh-2018-0284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Donald E Greydanus
- MD, DrHC (Athens), Founding Chair and Professor, Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA
| | - Joav Merrick
- MD, MMedSci, DMSc, Professor of Pediatrics, Department of Pediatrics, Mt Scopus Campus, Hadassah Hebrew University Medical Center and Director, National Institute of Child Health and Human Development, Jerusalem, Israel
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Porphyromonas asaccharolytica as a Rare Causative Agent for Lemierre's Syndrome. Case Rep Infect Dis 2018; 2018:3628395. [PMID: 30533234 PMCID: PMC6247719 DOI: 10.1155/2018/3628395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 10/16/2018] [Indexed: 02/07/2023] Open
Abstract
Lemierre's syndrome is a rare disease associated with significant morbidity and mortality. It begins with an oropharyngeal infection, which spreads locally to involve the internal jugular vein causing thrombophlebitis, followed by distant spread and metastatic infections. Affected individuals are commonly young adults. Causative organisms are usually oropharyngeal flora, most commonly being the anaerobe Fusobacterium necrophorum. Porphyromonas asaccharolytica is a rare etiological agent with only three cases being reported in the literature. This case report describes a previously healthy 22-year-old man who initially presented with acute tonsillitis and was later found to have left internal jugular vein thrombophlebitis along with bilateral septic emboli to the lungs. The patient was treated with a five-week course of ampicillin-sulbactam and metronidazole. Subsequent imaging also showed progression of internal jugular vein thrombus, for which warfarin was given for three months for anticoagulation.
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9
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Gottlieb M, Long B, Koyfman A. Clinical Mimics: An Emergency Medicine-Focused Review of Streptococcal Pharyngitis Mimics. J Emerg Med 2018. [PMID: 29523424 DOI: 10.1016/j.jemermed.2018.01.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Pharyngitis is a common disease in the emergency department (ED). Despite a relatively low incidence of complications, there are many dangerous conditions that can mimic this disease and are essential for the emergency physician to consider. OBJECTIVE This article provides a review of the evaluation and management of group A β-hemolytic Streptococcal (GABHS) pharyngitis, as well as important medical conditions that can mimic this disease. DISCUSSION GABHS pharyngitis often presents with fever, sore throat, tonsillar exudates, and anterior cervical lymphadenopathy. History and physical examination are insufficient for the diagnosis. The Centor criteria or McIsaac score can help risk stratify patients for subsequent testing or treatment. Antibiotics may reduce symptom duration and suppurative complications, but the effect is small. Rheumatic fever is uncommon in developed countries, and shared decision making is recommended if antibiotics are used for this indication. Oral analgesics and topical anesthetics are important for symptom management. Physicians should consider alternate diagnoses that may mimic GABHS pharyngitis, which can include epiglottitis, infectious mononucleosis, Kawasaki disease, acute retroviral syndrome, Lemierre's syndrome, Ludwig's angina, peritonsillar abscess, retropharyngeal abscess, and viral pharyngitis. A focused history and physical examination can help differentiate these conditions. CONCLUSIONS GABHS may present similarly to other benign and potentially deadly diseases. Diagnosis and treatment of pharyngitis should be based on clinical evaluation. Consideration of pharyngitis mimics is important in the evaluation and management of ED patients.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| | - Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
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10
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Vogt DM, Tüshaus L, Kaiser M, Russlies M. Pathological fracture of the femoral neck following septic coxitis and chronic osteomyelitis: a potential complication of Lemierre's syndrome. BMJ Case Rep 2017; 2017:bcr-2016-218474. [PMID: 28536211 DOI: 10.1136/bcr-2016-218474] [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
We portray the case of a 16-year-old girl who was initially admitted to the paediatric emergency department with non-specific symptoms of a severe cold and was first treated symptomatically on an ambulatory basis. Within 6 days she developed the full clinical picture of Lemierre's syndrome with the extraordinary manifestation of involvement of her right hip. Despite an interdisciplinary coordinated treatment as well as surgical therapy, a full-blown sepsis evolved within a short time period and resulted in almost 2 months of intensive care. While the primary focus could be successfully controlled, a progressive avascular necrosis of the right proximal femur developed on the basis of a chronic osteomyelitis. This finally led to a pathological fracture of the femoral neck. After excluding the possibility of an enduring bacterial infection, the fracture was treated with a total hip replacement.
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Affiliation(s)
- Dominik Maximilian Vogt
- Klinik für Orthopädie und Unfallchirurgie, Universitatsklinikum Schleswig Holstein - Campus Lübeck, Lübeck, Germany
| | - Ludger Tüshaus
- Klinik für Kinderchirurgie, Universitatsklinikum Schleswig Holstein - Campus Lübeck, Lübeck, Germany
| | - Martin Kaiser
- Klinik für Kinderchirurgie, Universitatsklinikum Schleswig Holstein - Campus Lübeck, Lübeck, Germany
| | - Martin Russlies
- Klinik für Orthopädie und Unfallchirurgie, Universitatsklinikum Schleswig Holstein - Campus Lübeck, Lübeck, Germany
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11
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Alperstein A, Fertig RM, Feldman M, Watford D, Nystrom S, Delva G, Muddassir S. Septic thrombophlebitis of the internal jugular vein, a case of Lemierre's syndrome. Intractable Rare Dis Res 2017; 6:137-140. [PMID: 28580216 PMCID: PMC5451747 DOI: 10.5582/irdr.2017.01021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
An 18-year-old gentleman with a history of recurrent tonsillitis presented to the emergency room complaining of worsening sore throat. He was found to have a peritonisillar abscess, and imaging revealed a non-occlusive left internal jugular vein thrombosis. Lemierre's syndrome is a rare, potentially fatal condition characterized by internal jugular vein thrombosis with septicemia following an acute oropharyngeal infection. While anticoagulation is the mainstay of treatment of deep venous thromboembolism (DVT) and pulmonary embolism (PE), the use of therapy is controversial in septic thrombophlebitis. This is counterintuitive since a common reported complication is pulmonary emboli. Early in the course of thrombophlebitis, while the thrombus is firmly attached, antibiotics may be all that is necessary to treat the condition.
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Affiliation(s)
- Adam Alperstein
- Oak Hill Hospital, Graduate Medical Education, Department of Internal Medicine, Brooksville, FL, USA
| | - Raymond M. Fertig
- University of Miami, Miller School of Medicine, Miami, FL, USA
- Address correspondence to: Dr. Raymond Fertig, University of Miami, Miller School of Medicine, Department of Dermatology and Cutaneous Surgery, 1475 NW 12th Ave, 2nd Floor Miami Florida, 33136, USA. E-mail:
| | - Matthew Feldman
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Daniel Watford
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Susan Nystrom
- Oak Hill Hospital, Graduate Medical Education, Department of Internal Medicine, Brooksville, FL, USA
| | - Guesly Delva
- Oak Hill Hospital, Graduate Medical Education, Department of Internal Medicine, Brooksville, FL, USA
| | - Salman Muddassir
- Oak Hill Hospital, Graduate Medical Education, Department of Internal Medicine, Brooksville, FL, USA
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12
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Lemierre syndrome: a rare complication of pharyngotonsillitis. Braz J Otorhinolaryngol 2015; 81:568-70. [PMID: 26324201 PMCID: PMC9448997 DOI: 10.1016/j.bjorl.2015.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 02/25/2015] [Accepted: 03/16/2015] [Indexed: 11/30/2022] Open
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13
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Kempen DHR, van Dijk M, Hoepelman AIM, Oner FC, Verlaan JJ. Extensive thoracolumbosacral vertebral osteomyelitis after Lemierre syndrome. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24 Suppl 4:S502-7. [PMID: 25245891 DOI: 10.1007/s00586-014-3576-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 09/04/2014] [Accepted: 09/04/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE To present a unique case of multilevel vertebral osteomyelitis after Lemierre syndrome. METHODS A previously healthy 27-year-old man presented in the Emergency Department in septic shock because of Lemierre syndrome for which he was subsequently treated with intravenous benzylpenicillin for 2 months. Two and a half months later, the patient was readmitted with severe back pain without neurological deficits or fever. Imaging revealed an extensive vertebral osteomyelitis of the complete thoracic, lumbar and sacral spine. RESULTS Although the blood cultures obtained at the initial admission for Lemierre syndrome revealed Fusobacterium species and Streptococcus milleri, the cultures from the spinal biopsies remained negative. Histology of the spinal biopsies showed a purulent sclerosing osteomyelitis. The patient was successfully treated with intravenous piperacillin and tazobactam. Despite persisting back pain, no recurrence of infection was seen at 3 years of follow-up. CONCLUSION Lemierre syndrome and an extensive thoracolumbosacral vertebral osteomyelitis are rare but serious infections. Clinicians must maintain a high index of suspicion for infectious metastases leading to vertebral osteomyelitis when a patient presents with back pain after an episode of life-threatening septicaemia caused by Lemierre syndrome.
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Affiliation(s)
- D H R Kempen
- Department of Orthopaedics, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands,
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14
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Nakamichi S, Izumikawa K, Inoue K, Sakamoto N, Ishimatsu Y, Kohno S, Ozono Y. [A unique Lemierre syndrome case in an elderly woman with deviation of the tongue]. KANSENSHOGAKU ZASSHI. THE JOURNAL OF THE JAPANESE ASSOCIATION FOR INFECTIOUS DISEASES 2014; 88:704-707. [PMID: 25672142 DOI: 10.11150/kansenshogakuzasshi.88.704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report herein on the case of a 71-year-old woman hospitalized for continued postauricular pain of unknown origin with tongue deviation. In view of the severe inflammatory reaction and multiple nodular shadows of the lungs, the existence of infectious disease was indicated. A contrast-enhanced CT scan of the neck revealed a thrombosis of the right internal jugular vein, osteomyelitis of right temporal-occipital bone and upper cervical spine, and cellulitis of the adjacent soft tissue. Multiple nodular shadows of the lungs were suspected to be the result of a metastatic septic embolism. Hence, she was diagnosed with Lemierre syndrome. Following treatment with long course of antimicrobial therapy including beta-lactams and clindamycin, complete recovery in this patient was achieved.
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15
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Aslanidis T, Myrou A, Giannakou-Peftoulidou M. Management of a young female patient with Fournier's gangrene and Lemierre's syndrome. Pan Afr Med J 2014; 18:275. [PMID: 25489369 PMCID: PMC4258208 DOI: 10.11604/pamj.2014.18.275.4602] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/06/2014] [Indexed: 11/11/2022] Open
Abstract
Fournier's gangrene is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions. Lemierre's syndrome is a condition characterized by thrombophlebitis of the internal jugular vein and bacteremia caused by primarily anaerobic organisms, following a recent oropharyngeal infection. Although the literature about either of them is rich, there is no report about co-appearance of the two syndromes. We present the case of a young healthy female patient who suffered concomitantly from Fournier's gangrene and Lemierre's syndrome after minor surgery.
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Affiliation(s)
- Theodoros Aslanidis
- Intensive Care Unit, Department of Anesthesia and Intensive care, "A.H.E.P.A" University Hospital, 1 St. Thessaloniki, Greece
| | - Athena Myrou
- Intensive Care Unit, Department of Anesthesia and Intensive care, "A.H.E.P.A" University Hospital, 1 St. Thessaloniki, Greece
| | - Maria Giannakou-Peftoulidou
- Intensive Care Unit, Department of Anesthesia and Intensive care, "A.H.E.P.A" University Hospital, 1 St. Thessaloniki, Greece
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16
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Boyd D, Paterson P, Dunphy L, Carton A, Hammersley N. A case report of Lemierre's Syndrome associated with dental sepsis. Scott Med J 2013; 58:e24-7. [PMID: 23596035 DOI: 10.1177/0036933012474609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Lemierre's syndrome is a potentially fatal condition characterised by spread of an oropharyngeal infection, resulting in thrombosis of the internal jugular vein. This leads to septicaemia and possible metastatic abscesses. CASE PRESENTATION We discuss the case of a previously healthy 17-year-old male who developed Lemierre's syndrome following dental sepsis. He presented with bilateral submandibular and submental swelling extending into the neck and chest. His management included a tracheostomy; incision and drainage of the abscesses; drainage of a pleural effusion and prolonged anticoagulant therapy. CONCLUSION The incidence of Lemierre's disease appears to be increasing and early diagnosis is essential. A high index of suspicion is needed in cases of oropharyngeal infection followed by fever, tender swelling of the neck and dysphagia - especially in young patients.
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Affiliation(s)
- D Boyd
- Oral and Maxillofacial Surgery Department, Monklands Hospital, UK
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17
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Golan E, Wong K, Alahmadi H, Agid RF, Morris A, Sharkawy A, Zadeh G. Endoscopic sphenoid sinus drainage in Lemierre syndrome. J Clin Neurosci 2013; 21:346-8. [PMID: 24060623 DOI: 10.1016/j.jocn.2013.02.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 02/01/2013] [Accepted: 02/09/2013] [Indexed: 10/26/2022]
Abstract
Lemierre syndrome is a rare condition arising from an invasive oropharyngeal infection, which leads to septic thrombophlebitis of the internal jugular vein and multi-organ septic embolization. Intracranial complications are rare but serious, including subdural empyema, cavernous sinus thrombosis, and internal carotid artery aneurysms. We report a patient with Lemierre syndrome with multiple intracranial complications despite aggressive antimicrobial therapy. The patient eventually required transsphenoidal endoscopic drainage of the sphenoid sinus to help eradicate the infectious source. We postulate that in patients with Lemierre syndrome with evidence of infection in the paranasal sinuses, endoscopic sinus drainage can be an adjunct to antimicrobial therapy in achieving infection control.
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Affiliation(s)
- E Golan
- Interdepartmental Division of Critical Care and Department of Medicine, University of Toronto, 399 Bathurst Street, 2 McLaughlin 411P, Toronto, ON Canada M5T 2S8; Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - K Wong
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - H Alahmadi
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - R F Agid
- Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - A Morris
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - A Sharkawy
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - G Zadeh
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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Murray M, Stevens T, Herford A, Roberts J. Lemierre syndrome: two cases requiring surgical intervention. J Oral Maxillofac Surg 2012; 71:310-5. [PMID: 22835986 DOI: 10.1016/j.joms.2012.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/01/2012] [Accepted: 05/02/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Matthew Murray
- Department of Oral and Maxillofacial Surgery, Loma Linda University Medical Center, Loma Linda, CA 92350, USA.
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Reply re: “Orbital Dissemination of Lemierre Syndrome From Gram-Positive Septic Emboli”. Ophthalmic Plast Reconstr Surg 2011. [DOI: 10.1097/iop.0b013e31822f9908] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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