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Cervicofacial Cellulitis due to Staphylococcus aureus with Jugular Vein Thrombosis and Multiple Septic Pulmonary Embolism: A Lemierre-Like Syndrome. Case Rep Infect Dis 2022; 2022:7805523. [PMID: 36062238 PMCID: PMC9439926 DOI: 10.1155/2022/7805523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
This is the case of a 28-year-old male patient with no particular pathological history who presented with an inflammatory swelling of the right cheek with pus in an infectious context. Cervicofacial CT with contrast injection allowed the diagnosis of a right cervicofacial cellulitis, associated with a jugular venous thrombosis extending to the superior vena cava. It also revealed septic pulmonary metastases in the form of multiple excavated pulmonary nodules. The analysis of the pus sample allowed the isolation of Staphylococcus aureus as the causative germ. This led to the diagnosis of a Lemierre-like syndrome, which is a variant of the Lemierre syndrome. Despite appropriate antibiotic treatment and anticoagulation, the patient died after 16 days of hospitalization.
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2
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Kitano D, Yonezawa K, Iwae S, Sakakibara S. Internal jugular vein thrombosis and pulmonary thromboembolism after head and neck reconstructive surgery. J Plast Reconstr Aesthet Surg 2020; 74:1239-1245. [PMID: 33288470 DOI: 10.1016/j.bjps.2020.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 10/07/2020] [Accepted: 11/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Free flap failure secondary to internal jugular vein thrombosis (IJVT) is a significant complication after head and neck reconstructive surgery. A consensus has not yet been reached among reconstructive surgeons regarding the treatment of IJVT. METHODS We retrospectively evaluated the incidence of IJVT in 118 patients who underwent free flap reconstruction at Hyogo Cancer Center, Akashi, Japan. The occurrence of IJVT-related flap circulation crisis and pulmonary thromboembolism (PTE) was studied. This study was approved by the institutional ethics committee, and written informed consent was obtained from each patient. RESULTS From 118 patients who underwent head and neck reconstructive surgery, we included 116 internal jugular veins (IJVs) preserved after neck dissection in the present study. IJVT was confirmed in 25 (21.6%) IJVs from 23 patients. One patient (0.8%) developed venous congestion due to IJVT, which resulted in total flap necrosis. Two patients (1.7%) exhibited PTE associated with IJVT. They were treated with direct oral anticoagulants for 3 months and were discharged without any sequelae. CONCLUSION Our results suggest that IJVT after head and neck reconstructive surgery caused not only flap circulation crisis but also PTE. Reconstructive surgeons should be aware of the potential risks due to serious complications associated with IJVT.
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Affiliation(s)
- D Kitano
- Department of Plastic Surgery, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo 673-8558, Japan; Department of Plastic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - K Yonezawa
- Department of Head and Neck Surgery, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo 673-0021, Japan
| | - S Iwae
- Department of Head and Neck Surgery, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo 673-0021, Japan
| | - S Sakakibara
- Department of Plastic Surgery, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo 673-8558, Japan; Department of Plastic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
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3
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CT Chest in Cavitary Lung Disease. Chest 2018; 153:1513-1515. [DOI: 10.1016/j.chest.2018.03.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 11/17/2022] Open
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Gumussoy M, Arslan IB, Cukurova I, Uluyol S. Internal jugular vein thrombosis due to heterozygote methylene tetrahydrofolate reductase (MTHFR) 1298C and Factor V G1691A mutations after a minor trauma. Natl J Maxillofac Surg 2015; 5:180-3. [PMID: 25937730 PMCID: PMC4405961 DOI: 10.4103/0975-5950.154824] [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] [Indexed: 12/02/2022] Open
Abstract
Internal jugular vein thrombosis usually appears in central venous catheterization, distant malignancies, hypercoagulation, infections, or secondary to ovarian hyperstimulation syndrome. A 44-year-old female patient presented to us with sore throat, and pain and swelling on the right side of her neck. She had a history of simple neck trauma 10 days ago. Ultrasonography and computed tomography showed bilateral multiple lymphadenopathies and right internal jugular vein thrombosis. Patient was put on parenteral antibiotherapy and oral anticoagulant treatment. Genomic DNA tests for hypercoagulation revealed methylene tetrahydrofolate reductase 1298C heterozygote mutation and Factor V G1691A (Leiden) mutation. Patient has been under clinical control for 1 year and does not have any complaints. In this article, diagnosis, treatment, and the etiology of internal jugular vein thrombosis, which is a rare and potentially fatal condition, have been discussed through this case.
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Affiliation(s)
- Murat Gumussoy
- Department of Otolaryngology and Head and Neck Surgery, The Ministry of Health, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ilker B Arslan
- Department of Otolaryngology and Head and Neck Surgery, The Ministry of Health, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ibrahim Cukurova
- Department of Otolaryngology and Head and Neck Surgery, The Ministry of Health, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Sinan Uluyol
- Department of Otolaryngology and Head and Neck Surgery, The Ministry of Health, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
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Congenital agenesis of the internal jugular vein: an extremely rare anomaly. Case Rep Surg 2015; 2015:637067. [PMID: 25821625 PMCID: PMC4363641 DOI: 10.1155/2015/637067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/09/2015] [Indexed: 11/18/2022] Open
Abstract
Vascular anomalies of major venous vessels are rarely seen. Moreover, congenital absence of internal jugular vein is extremely uncommon. In our case, a female patient presented with primary unknown left cervical mass. Cervical ultrasonography demonstrated absence of right internal jugular vein. In addition, computed tomography and dynamic magnetic resonance imaging scans confirmed this diagnosis. Compensatory left internal jugular vein enlargement mimicked sort of cervical mass. Venous magnetic resonance imaging images revealed the absence of right internal jugular vein with compensatory left internal jugular vein dominance. In the literature, the agenesis of IJV was mentioned in a case with concomitant multiple problems. Here, an asymptomatic case is reported with an incident diagnosis. No interventions were planned upon the patient's request. It should be kept in mind that any kind of anomalies can be seen during venous access and neck surgery.
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6
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Clinical characteristics of septic pulmonary embolism in adults: A systematic review. Respir Med 2014; 108:1-8. [DOI: 10.1016/j.rmed.2013.10.012] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 10/02/2013] [Accepted: 10/08/2013] [Indexed: 11/23/2022]
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Abstract
We report a case of Lemierre syndrome secondary to Streptococcus pyogenes in a 22-month-old girl. This case report and literature review took place at a pediatric intensive care unit at a freestanding tertiary children's hospital. Diagnosis occurred after the discovery of left internal jugular thrombus and multiple metastatic infection sites including the right knee, kidneys, lungs, and brain. Lemierre syndrome can occur in young children secondary to S. pyogenes, and a classic presentation may not occur. A high index of suspicion is crucial to the diagnosis.
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8
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Spontaneous internal jugular vein thrombosis: a case report. Kaohsiung J Med Sci 2011; 26:679-81. [PMID: 21186018 DOI: 10.1016/s1607-551x(10)70104-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 02/23/2010] [Indexed: 11/21/2022] Open
Abstract
Internal jugular vein thrombosis (IJVT) is an elusive vascular disease that is rarely seen, with potentially lethal complications such as sepsis and pulmonary embolism. Spontaneous IJVT is considered when no apparent predisposing cause of thrombosis is present. A previously healthy, 31-year-old woman presented to the university-based emergency department because of painless swelling in the right anterior side of her neck. Physical examination revealed a painless, soft and immobile mass in the right anterior side of her neck beneath the sternocleidomastoid muscle, without hyperemia or local heat. On ultrasonographic examination, a hyperechogenic mass was visualized around the thoracic entrance of the right internal jugular vein, which was suggestive of a thrombus. The patient was administered intravenous antibiotic and low-molecular-weight heparin followed by oral coumadin as anticoagulant therapy. Her complaints were relieved within 5 days. She was completely well after 6 months. Venous thrombosis generally results from impaired blood flow locally or systemically that leads to activation of coagulation. Primary care physicians should sustain a high index of suspicion in patients who present with undiagnosed swelling in the neck, or other signs and symptoms attributed to IJVT.
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10
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Lemierre Syndrome With Contralateral Thrombosis of the Internal Jugular Vein. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2009. [DOI: 10.1097/ipc.0b013e318188db80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Ameen Alherabi
- Department of Otolaryngology/Head & Neck Surgery, Umm Al-Qura University, Al-Noor Specialist Hospital, Makkah, Saudi Arabia.
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Septic thrombophlebitis with acute osteomyelitis in adolescent children: a report of two cases and review of the literature. Int J Emerg Med 2008; 1:155-9. [PMID: 19384672 PMCID: PMC2657235 DOI: 10.1007/s12245-008-0006-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 02/05/2008] [Indexed: 11/10/2022] Open
Abstract
The triad of acute osteomyelitis, deep venous thrombophlebitis, and septic pulmonary embolism is a rare, but life-threatening syndrome in children that requires prompt recognition and treatment. We report two cases of acute osteomyelitis complicated by septic thrombophlebitis and pulmonary emboli. Both patients required operative drainage to remove the septic focus. Recognition of any one component of the triad should prompt a search for the other associated disorders. Aggressive management with early antibiotic administration, anticoagulation, and surgical debridement can be life saving.
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Ballesteros García MM, Gil Pons E, Medina Monzón C, Baquero Cano M, Martínez Gutiérrez A, Osé Palomares J. [Lemierre's syndrome]. An Pediatr (Barc) 2007; 66:417-8. [PMID: 17430721 DOI: 10.1157/13101249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Mattar CS, Keith RL, Byrd RP, Roy TM. Septic pulmonary emboli due to periodontal disease. Respir Med 2006; 100:1470-4. [PMID: 16376534 DOI: 10.1016/j.rmed.2005.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Revised: 10/26/2005] [Accepted: 11/14/2005] [Indexed: 10/25/2022]
Abstract
Septic pulmonary embolization (SPE) is a rare but serious disorder. It is a well-recognized potential problem in the settings of tricuspid valve endocarditis, septic thrombophlebitis, infected central venous catheters, and postanginal septicemia. Less well documented is the occurrence of SPE in patients with periodontal disease without suppurative thrombophlebitis of the great vessels of the neck. We report a patient with SPE in whom periodontal disease was the only identifiable nidus of infection and review the literature regarding the four other patients reported to have suffered this complication.
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Affiliation(s)
- Costy S Mattar
- The Veterans Affairs Medical Center 111-B, P.O. Box 4000, Mountain Home, TN 37684-4000, and Division of Pulmonary Diseases and Critical Care Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
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Cho YP, Choi SJ, Jung BH, Hwang JW, Han MS, Kim YH, Kwon TW, Lee SG. Lemierre's syndrome in a patient with antiphospholipid syndrome. Ann Vasc Surg 2006; 20:274-7. [PMID: 16557426 DOI: 10.1007/s10016-006-9004-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2005] [Revised: 05/07/2005] [Accepted: 01/24/2006] [Indexed: 10/24/2022]
Abstract
Internal jugular vein thrombosis is usually associated with intravenous drug abuse, long-term venous catheterization, local infection, or spontaneous occlusion. The antiphospholipid syndrome is now recognized as one of the commonest causes of acquired arterial or venous thrombosis. Lemierre's syndrome is an uncommon but potentially lethal complication of internal jugular vein thrombosis after an oropharyngeal infection. A 34-year-old man presented with fever and progressive, painful right neck swelling 6 days after an episode of pharyngitis. Clinical studies including radiological and laboratory tests confirmed the diagnosis of Lemierre's syndrome associated with antiphospholipid syndrome. Although Lemierre's syndrome is a well-known cause of internal jugular vein thrombosis, association with antiphospholipid syndrome is very rare.
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Affiliation(s)
- Yong Pil Cho
- Department of Surgery, University of Ulsan Medical College, Gangneung Asan Hospital, Gangneung, Republic of Korea.
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Blaise S, Colombe B, Millet C, Poulain C, Bosseray A, Carpentier PH, Debru JL. [Jugular thrombosis with fever: what about Lemierre syndrome?]. ACTA ACUST UNITED AC 2005; 30:231-2. [PMID: 16292201 DOI: 10.1016/s0398-0499(05)88208-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Charles K, Flinn WR, Neschis DG. Lemierre’s syndrome: A potentially fatal complication that may require vascular surgical intervention. J Vasc Surg 2005; 42:1023-5. [PMID: 16275466 DOI: 10.1016/j.jvs.2005.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2005] [Accepted: 07/07/2005] [Indexed: 11/22/2022]
Abstract
Septic phlebitis of the internal jugular vein, Lemierre's syndrome, is extremely rare. However, Lemierre's syndrome may cause septic pulmonary emboli or result in fatal systemic sepsis, or both, if a timely diagnosis and appropriate treatment are not provided. We present a case of Lemierre's syndrome that occurred in an otherwise healthy young man. In this case, progression to a moribund state was rapid, and surgical intervention proved lifesaving.
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Affiliation(s)
- Kirk Charles
- Division of Vascular Surgery, University of Maryland Medical Center, Baltimore, MD 21201, USA
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Affiliation(s)
- David Kirsch
- Department of Radiology, Louisiana State University Health Sciences Center and VA Medical Center, New Orleans
| | - Devin Tighe
- Department of Radiology, Louisiana State University Health Sciences Center and VA Medical Center, New Orleans
| | - Michael G. D'Antonio
- Department of Radiology, Louisiana State University Health Sciences Center and VA Medical Center, New Orleans
| | - Enrique Palacios
- Department of Radiology, Louisiana State University Health Sciences Center and VA Medical Center, New Orleans
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