1
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Koukias S, Athousaki A, Klonaris D, Kavousanaki M, Papazoglou G, Papanikolaou N. Lemierre Syndrome with Extensive Thrombosis: A Unique Case Report and Literature Review. Case Rep Otolaryngol 2024; 2024:6335543. [PMID: 39257960 PMCID: PMC11387079 DOI: 10.1155/2024/6335543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 08/12/2024] [Accepted: 08/28/2024] [Indexed: 09/12/2024] Open
Abstract
Background Lemierre syndrome (LS) is a rare complication of upper aerodigestive tract infections characterized by proximal and distal septic emboli, commonly including internal jugular vein (IJV) thrombosis. Diagnosis can be challenging, and treatment delays can result in increased patient morbidity and mortality. We present a rare case of LS with extensive thrombosis and multiple sites of distal infection and a narrative review of the literature. Case Presentation. A 52-year-old Caucasian male was transferred to the emergency department (ED) with an altered level of consciousness and clinical findings of acute bacterial pharyngotonsillitis. Medical history included cervical spine disorder and traumatic brain injury in the past, as well as the recent use of pain relievers due to acute cervical pain. Imaging studies revealed left IJV thrombosis that extended into multiple venous cerebral sinuses and infiltrates of the right lung. LS was considered the most likely diagnosis. The patient was intubated and transferred to the intensive care unit (ICU). Treatment included intravenous broad-spectrum antibiotics and anticoagulation therapy. Response to treatment was satisfactory. After extubation, he was transferred to a ward and discharged with resolution of clinical and imaging findings. Conclusion LS is a rare disease and may have an insidious course. Timely diagnosis and appropriate treatment strategies, mainly broad-spectrum antibiotics, offer favorable outcomes in otherwise healthy individuals. The indications for anticoagulation therapy still remain controversial. Anticoagulants are usually administered to patients with extensive thrombosis. Surgical treatment includes abscess drainage, while IJV ligation and excision are reserved for nonresponders to medical treatment.
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Affiliation(s)
- Stergos Koukias
- 1st Department of Internal Medicine General Hospital of Heraklion "Venizeleio-Pananeio", Heraklion, Crete, Greece
| | - Asimenia Athousaki
- 1st Department of Internal Medicine General Hospital of Heraklion "Venizeleio-Pananeio", Heraklion, Crete, Greece
| | - Dionisios Klonaris
- Department of Otorhinolaryngology-Head and Neck Surgery General Hospital of Heraklion "Venizeleio-Pananeio", Heraklion, Crete, Greece
| | - Melina Kavousanaki
- 1st Department of Internal Medicine General Hospital of Heraklion "Venizeleio-Pananeio", Heraklion, Crete, Greece
| | - Georgios Papazoglou
- 1st Department of Internal Medicine General Hospital of Heraklion "Venizeleio-Pananeio", Heraklion, Crete, Greece
| | - Nikolaos Papanikolaou
- 1st Department of Internal Medicine General Hospital of Heraklion "Venizeleio-Pananeio", Heraklion, Crete, Greece
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2
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Pan Y, Shi Z, Ye B, Da Q, Wang C, Shen Y, Xiang M. Surgical intervention of Lemierre's syndrome: a case report and review of the literature. J Med Case Rep 2024; 18:265. [PMID: 38816729 PMCID: PMC11140976 DOI: 10.1186/s13256-024-04584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/22/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Lemierre's syndrome is a fatal and rare disease that is typically characterized by oropharyngeal infection and internal jugular vein thrombosis. Timely institution of appropriate antibiotics is the standard treatment. CASE PRESENTATION The authors report a case of Lemierre's syndrome. A 67-year-old male patient of Han ethnicity in China suffered from a large inflammatory neck mass involving left internal jugular vein thrombosis diagnosed as Lemierre's syndrome and finally cured by surgical treatment. In addition, a literature review was carried out through PubMed using the terms "Lemierre's syndrome/disease and review, meta-analysis or retrospective study" and "Lemierre's syndrome/disease and internal jugular vein". This search yielded six articles that recorded surgical methods such as drainage, craniotomy, tooth extraction, and ligation of the occluded vein to give clinicians more ideas about the treatment of the Lemierre's syndrome. CONCLUSION This is the first review to summarize the conditions under which surgical treatment are conducted. Additionally, this is the first report of such a large inflammatory neck mass that was completely cured by surgical resection and internal jugular vein ligation. The authors also offer several conclusions regarding surgical intervention in Lemierre's syndrome for the first time.
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Affiliation(s)
- Yiqi Pan
- Department of Otolaryngology and Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhihong Shi
- Department of Otolaryngology and Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Ye
- Department of Otolaryngology and Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Da
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chaofu Wang
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yilin Shen
- Department of Otolaryngology and Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Mingliang Xiang
- Department of Otolaryngology and Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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3
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Sapkota S, Shrestha S, Sharma S, Sapkota S, Solis LA, Kalla A. Fusobacterium bacteremia presenting with inferior mesenteric vein thrombosis. Clin Case Rep 2023; 11:e7617. [PMID: 37397578 PMCID: PMC10310899 DOI: 10.1002/ccr3.7617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 07/04/2023] Open
Abstract
Isolated mesenteric vein thrombosis associated with Fusobacterium is rare. Physicians should be aware regarding the association of Fusobacterium with thrombosis at various sites.
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Affiliation(s)
| | - Suraj Shrestha
- Maharajgunj Medical CampusInstitute of MedicineKathmanduNepal
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4
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Septic Thrombophlebitis of the Internal Jugular Vein in an Immunocompromised Patient with Lemierre Syndrome: A Case Report. Transplant Proc 2022; 54:1388-1390. [DOI: 10.1016/j.transproceed.2022.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/16/2022] [Accepted: 03/24/2022] [Indexed: 11/17/2022]
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5
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Gore MR. Lemierre Syndrome: A Meta-analysis. Int Arch Otorhinolaryngol 2020; 24:e379-e385. [PMID: 32754251 PMCID: PMC7394644 DOI: 10.1055/s-0039-3402433] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 10/20/2019] [Indexed: 12/11/2022] Open
Abstract
Introduction
Lemierre syndrome, or postpharyngitis anaerobic sepsis, is an infrequent but life-threatening infection that often involves thrombosis of the internal jugular vein. The role of anticoagulation in addition to antibiotics and surgical treatment remains uncertain.
Objectives
1) To perform a meta-analysis on outcomes and treatment of Lemierre syndrome; and 2) to evaluate the effect of anticoagulation in Lemierre syndrome on vessel recanalization and on mortality.
Data Synthesis
A Pubmed database search was conducted using the keywords
Lemierre syndrome
. A total of 427 studies were identified and reviewed. Data were extracted on patient demographics, treatment type including use and type of anticoagulation, type of antibiotics, presence and location of vessel thrombosis, presence of cranial neuropathies, recanalization of thrombosed vessels on follow-up imaging, organisms isolated on wound or blood cultures, and mortality. The primary outcome variables examined were the effect of anticoagulation on vessel recanalization and mortality. After the review, 359 studies totaling 394 patients between 1990 and 2017 had partial or complete data that could be analyzed. In total, 50 patients had sufficient data on the effect of anticoagulation on vessel recanalization, and 194 had sufficient data on the effect of anticoagulation on mortality. The odds ratio for anticoagulation and vessel recanalization was 1.6 (95% confidence interval = 0.3 to 9.4;
p
= 0.6). The odds ratio for anticoagulation and death was 0.6 (95% confidence interval = 0.1 to 2.9;
p
= 0.5).
Conclusion
The present meta-analysis did not demonstrate a statistically significant effect on vessel recanalization or mortality for patients treated with anticoagulation versus patients not anticoagulated in the Lemierre syndrome literature.
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Affiliation(s)
- Mitchell R Gore
- Department of Otolaryngology, State University of New York Upstate Medical University, Syracuse, New York, United States
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6
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Rohowetz LJ, Gratton SM, Dansdill D, Miller CJ, Dubin S. Cavernous sinus thrombosis caused by Streptococcus constellatus-associated Lemierre syndrome presenting as an isolated abducens nerve palsy. Am J Ophthalmol Case Rep 2020; 18:100592. [PMID: 32123771 PMCID: PMC7037586 DOI: 10.1016/j.ajoc.2020.100592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/15/2019] [Accepted: 01/02/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose To describe a patient with Streptococcus constellatus-associated Lemierre syndrome complicated by eventual cavernous sinus thrombosis (CST) that manifested as an isolated abducens nerve palsy. Observations A patient with a history of heavy alcohol use presented with Lemierre syndrome caused by an odontogenic infection due to Streptococcus constellatus. Despite initiation of intravenous antibiotics and eventual eradication of her bacteremia, she developed an isolated abducens nerve palsy on hospital day 7 due to associated CST. Conclusions and Importance CST is a rare complication of odontogenic infection and Lemierre syndrome. This case demonstrates the potential for primary odontogenic infections to progress to life- and sight-threatening diseases. This case also illustrates the importance of considering uncommon pathogens as the etiology of CST based on the suspected source of primary infection.
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Affiliation(s)
| | | | | | | | - Sarah Dubin
- Corresponding author. Department of Internal Medicine University of Missouri, Kansas City 2411 Holmes St, Kansas City, MO, 64108, USA.
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7
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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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8
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Campo F, Fusconi M, Ciotti M, Diso D, Greco A, Cattaneo CG, de Vincentiis M. Antibiotic and Anticoagulation Therapy in Lemierre's Syndrome: Case Report and Review. J Chemother 2019; 31:42-48. [PMID: 30773133 DOI: 10.1080/1120009x.2018.1554992] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Lemierre's syndrome is a rare and fatal disease and is also known as the forgotten disease to describe the rarity of this syndrome in the antibiotic era. However, in the last 20 years, the incidence of this disease has been increasing. Authors report a case of Lemierre's syndrome with extensive venous thrombosis involving right internal jugular veins with extension to the sigmoid and lateral sinus and also review the literature on the use of anticoagulant therapy in Lemierre's syndrome. A computerized Medline study was carried out through the use of PUBMED: using the Medical Subject Headings terms 'Lemierre Syndrome/diagnosis' and words 'Lemierre's syndrome and anticoagulation'. From this, authors found 64 articles from 2002 to January 2018 with a total of 165 patients. The purpose of our review is to emphasize that antibiotic therapy should be started immediately, while anticoagulant therapy should be started in selected cases. Anticoagulation should be carried out in absence of any contraindication or presumed risk following clinical anticoagulation guidelines and only in patients with poor clinical response despite antibiotics therapy, predisposing thrombophilia and intracranial thrombosis.
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Affiliation(s)
- Flaminia Campo
- a Department of Sensory Organs , University ''Sapienza'' of Rome , Rome, Italy
| | - Massimo Fusconi
- a Department of Sensory Organs , University ''Sapienza'' of Rome , Rome, Italy
| | - Mario Ciotti
- b Department of Radiotherapy , ENT Special Service of Radiology, University ''Sapienza'' of Rome , Rome, Italy
| | - Daniele Diso
- c Department of Thoracic Surgery , 'Sapienza' University of Rome , Rome , Italy
| | - Antonio Greco
- a Department of Sensory Organs , University ''Sapienza'' of Rome , Rome, Italy
| | | | - Marco de Vincentiis
- a Department of Sensory Organs , University ''Sapienza'' of Rome , Rome, Italy
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9
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Coburn JA, Golden E, Brucker J, Kennedy TA. Nontraumatic Vascular Emergencies of the Neck. Semin Ultrasound CT MR 2019; 40:157-171. [PMID: 31030739 DOI: 10.1053/j.sult.2018.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Nontraumatic vascular emergencies of the head and neck are uncommon, but can occur in patients with central venous catheters, head and neck infections, and in patients with head and neck cancer. Recognizing the imaging findings of vascular complications in these patient populations is critically important to ensure expeditious treatment to avoid significant morbidity and mortality.
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Affiliation(s)
- John A Coburn
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Edwarda Golden
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Justin Brucker
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tabassum A Kennedy
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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10
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Paker M, Cohen JT, Moed N, Shleizerman L, Masalha M, Ashkenazi D, Mazzawi S. Facial vein thrombophlebitis: A case report and literature review. Int J Pediatr Otorhinolaryngol 2018; 113:298-301. [PMID: 30174005 DOI: 10.1016/j.ijporl.2018.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/02/2018] [Accepted: 08/13/2018] [Indexed: 11/30/2022]
Abstract
Septic thrombophlebitis of the facial vein (STFN) commonly presents with facial erythema, tenderness, and swelling above the involved vessel. Due to its rarity, diagnosis and treatment remain a challenge. Lemierre syndrome (LS), which consists of a triad of internal jugular vein thrombophlebitis, septicemia, and distant septic emboli, is a more common entity of which physicians are more familiar. Whether tonsillitis-related STFN is actually LS in a different anatomical area and shares the same characteristics is still left to be answered. We present a case of STFN with a review of all cases reported in the literature.
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Affiliation(s)
- Miki Paker
- Department of Otolaryngology Head and Neck Surgery, "Haemek" Medical Center, Afula, Israel.
| | - Jacob T Cohen
- Department of Otolaryngology Head and Neck Surgery, The Head and Neck Center, Rambam Health Care Campus, Haifa, Israel; Rappaport Institute of Medicine and Research, The Technion - Israel Institute of Technology, Haifa, Israel.
| | - Nedal Moed
- Department of Otolaryngology Head and Neck Surgery, "Haemek" Medical Center, Afula, Israel.
| | - Lev Shleizerman
- Department of Otolaryngology Head and Neck Surgery, "Haemek" Medical Center, Afula, Israel.
| | - Muhamed Masalha
- Department of Otolaryngology Head and Neck Surgery, "Haemek" Medical Center, Afula, Israel.
| | - Dror Ashkenazi
- Department of Otolaryngology Head and Neck Surgery, "Haemek" Medical Center, Afula, Israel.
| | - Salim Mazzawi
- Department of Otolaryngology Head and Neck Surgery, "Haemek" Medical Center, Afula, Israel.
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11
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Yang X, Yang YF, Zhu ZC, Xu TS, Cheng YN, Sun ZY. Senile Lemierre syndrome complicated with descending necrotizing mediastinitis: A case report. Medicine (Baltimore) 2018; 97:e11903. [PMID: 30170383 PMCID: PMC6392631 DOI: 10.1097/md.0000000000011903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Senile patients with LS complicated with DNM are rarely seen in clinical practice, and extensive cervical incision and drainage plus administration of effective antibiotics are the basis for treatment. Currently, the treatment controversy mainly has focused on whether mediastinal incision and drainage is necessary for patients with type I DNM, and whether anticoagulation therapy is required for jugular venous emboli and distant metastatic emboli induced by LS. PATIENT CONCERNS A female, 76 years old, developed pain of tonsil on right side 5 days ago, and felt that the pain aggravated complicated with dysphagia and swelling pain of neck on both sides since then. DIAGNOSES She was diagnosed with LS complicated with type I DNM. INTERVENTIONS Tazobactam and Piperacillin 4.5 q8h and Ornidazole 100 ml q6h ivgtt were administered empirically,and secondary extensive cervical incision and drainage was performed under general anesthesia, after which low molecular weight heparin 4250 U q12h SC was administered. G test was performed 3 days later, which showed (1,3)-β-D-glucan >1000 pg/ml. Bridging anticoagulation therapy, low molecular weight heparin 4250 U q12h SC, and Warfarin 2.5 mg qd po were given one week later. Low molecular weight heparin SC was discontinued and only Warfarin po was administered after treatment of bridging therapy for 3 days. OUTCOMES CT of head and neck was reexamined on post-admission d24 and revealed that neck infection was improved on both sides, jugular vein distension on right side was restored to normal, abscess and pneumatosis of superior mediastinum were improved, distension of pulmonary artery on both sides was normalized, WBC was 9.94×109/L, neutrophil count was 4.43×109/L, CRP level was 9.8mg/L, D-D level was 0.81mg/L, PCT level was 0.800ng/mL and G test suggested (1,3)-β-D-glucan pf 27.1 pg/mL. LESSONS Concomitant use of anticoagulants on the basis of repeated cervical incision and drainage + administration of effective antibiotics can obtain excellent therapeutic efficacy in the treatment of patient with LS complicated with type I DNM.
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Abstract
Lemierre's syndrome is a rare and feared complication of pharyngitis, occurring most commonly in adolescents and young adults. It is typically defined by the constellation of septic internal jugular vein thrombophlebitis, pulmonary and other septic emboli, and sterilesite infection by Fusobacterium necrophorum. The rarity and severity of Lemierre's syndrome has made it an attractive subject for case reports but there is a paucity of evidence to inform areas of persistent uncertainty. In recent years, heightened attention and controversy has focused upon speculation that a purported rise in the incidence of Lemierre's syndrome is due to reduced antibiotic prescribing for respiratory tract infections, that F. necrophorum is an under-appreciated cause of acute tonsillopharyngitis and that testing and targeted treatment would prevent cases of Lemierre's syndrome.
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13
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Stubington TJ, James P. Lemierre's syndrome: a pain in the neck with far-reaching consequences. BMJ Case Rep 2018; 2018:bcr-2017-222723. [PMID: 29298792 DOI: 10.1136/bcr-2017-222723] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Lemierre's syndrome is a potentially life-threatening consequence of oropharyngeal and ear infections and often results in critical care admission and even intubation. Due to the multisystem manifestation, multiple teams may initially be involved in the care, some of which may be unfamiliar with the features and usual clinical course. This report describes a case in a 36-year-old woman with the classic features of internal jugular vein thrombosis and septic emboli to the lungs secondary to an oropharyngeal infection. Treatment comprised antibiotic therapy, anticoagulation and fluid resuscitation, and was carried out in a high dependency unit setting. At follow-up 3 months after discharge, the patient was well with no residual symptoms off all treatment. During the events of this case, it became apparent that while ear, nose and throat and infectious diseases team members were relatively familiar with the condition, other departments including the critical care team were less so.
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Affiliation(s)
| | - Paul James
- Critical Care, Queen's Medical Centre Nottingham, Nottingham, UK
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14
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Trombosis venosa yugular interna, una localización atípica de enfermedad tromboembólica venosa. Med Clin (Barc) 2017; 149:459-460. [DOI: 10.1016/j.medcli.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 07/31/2017] [Accepted: 08/06/2017] [Indexed: 11/20/2022]
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15
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Miyamoto S, Toi T, Kotani R, Iwakami T, Yamada S, Nishido H, Suzuki Y, Ishikawa H, Murakami M, Hoya K. Lemierre Syndrome Associated with Ipsilateral Recurrent Laryngeal Nerve Palsy: A Case Report and Review. NMC Case Rep J 2017; 3:53-57. [PMID: 28663998 PMCID: PMC5386166 DOI: 10.2176/nmccrj.cr.2015-0226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 11/26/2015] [Indexed: 11/20/2022] Open
Abstract
Lemierre syndrome (LS) is a rare life-threatening disease that is often caused by an acute oropharyngeal infection with a secondary thrombophlebitis of the internal jugular vein. LS rarely manifests as cranial nerve palsy. To the best of our knowledge, this is the second case report of LS associated with recurrent laryngeal nerve palsy. A 66-year-old female presented to a dental clinic with gingivitis and sore throat. Due to moderate periodontitis, her left first upper molar was extracted. A few days later, she subsequently developed a coarse voice and occipital headaches, and was referred to an otolaryngologist. She was diagnosed with left recurrent laryngeal nerve palsy and subsequent left-sided otitis media, and was referred to us for persistent headaches. She intermittently presented with high-grade fever and complained of salty taste disturbance. Her head magnetic resonance imaging (MRI) revealed left mastoiditis, thrombosis in the left transverse and sigmoid sinus, and left internal jugular vein. Her laboratory tests revealed an elevated white blood cell count, levels of C-reactive protein, and D-dimer. No endogenous coagulopathy was confirmed. Although, blood and cerebrospinal fluid culture grew no microorganisms, respectively, the empirically determined antibiotic therapy was initiated. In a week, the patient defervesced and had no headaches despite persistent thrombosis. Early diagnosis and an immediate antibiotic treatment are crucial for LS patients. Anticoagulation therapy was not needed for our patient and is still controversial for LS.
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Affiliation(s)
- Shinya Miyamoto
- Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba
| | - Teruo Toi
- Department of Otolaryngology, Mitsuwadai General Hospital, Chiba, Chiba
| | - Ryosuke Kotani
- Department of Otolaryngology, Teikyo University Chiba Medical Center, Ichihara, Chiba
| | - Takayuki Iwakami
- Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba
| | - So Yamada
- Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba
| | - Hajime Nishido
- Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba
| | - Yasutaka Suzuki
- Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba
| | - Hisashi Ishikawa
- Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba
| | - Mineko Murakami
- Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba
| | - Katsumi Hoya
- Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba
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16
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Osman M, Hasan S, Bachuwa G. Oesophageal cancer presenting as Lemierre's syndrome caused by Streptococcus anginosus. BMJ Case Rep 2017; 2017:bcr-2017-219661. [PMID: 28416472 DOI: 10.1136/bcr-2017-219661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 59-year-old man presented to the emergency department with complaints of dysphagia, right-sided neck swelling, fever and chills. Physical examination was remarkable for fever and tender swelling over the right side of the neck. Laboratory investigations revealed leucocytosis with neutrophilia. CT of the neck showed right internal jugular vein thrombosis with an overlying abscess and a nodular opacity in the right lung apex with air locules. He underwent surgical drainage of the neck abscess. Aerobic cultures from the drainage and blood cultures grew Streptococcus anginosus Given his initial complaint of dysphagia, upper endoscopy was performed which showed a mass in the upper oesophagus. Histopathology confirmed squamous cell carcinoma. The patient received 6 weeks of antibiotics therapy.
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Affiliation(s)
| | - Saqib Hasan
- Infectious Disease, Hurley Medical Center, Flint, Michigan, USA
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Gastrointestinal Variant of Lemierre Syndrome: Fusobacterium nucleatum Bacteremia-Associated Hepatic Vein Thrombosis: a Case Report and Literature Review. Am J Ther 2017; 23:e933-6. [PMID: 24942004 DOI: 10.1097/mjt.0000000000000084] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fusobacterium nucleatum is a gram-negative bacillius commonly found in oropharynx and is traditionally associated with Lemierre syndrome, which is characterized by history of recent oropharyngeal infection, internal jugular vein thrombosis, and isolation of anaerobic pathogens, mainly Fuosobacterium necrophorum. However, recent evidence indicated that F. nucleatum is also a normal resident of human gut. Less than a dozen of case reports had linked F. nucleatum to gastrointestinal variant of Lemierre syndrome with portal vein thrombosis. However, F. nucleatum bacteremia-associated hepatic vein thrombosis is very rare. We report a case of a 73-year-old man who had hepatic vein thrombosis associated with F. nucleatum bacteremia, most likely from subclinical primary infection affecting the lower gastrointestinal tract. The underlying pathophysiology and treatment options are discussed here. With rapid increase in reporting of Lemierre syndrome, this case deserves particular attention from clinicians.
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Johannesen KM, Bodtger U. Lemierre's syndrome: current perspectives on diagnosis and management. Infect Drug Resist 2016; 9:221-227. [PMID: 27695351 PMCID: PMC5028102 DOI: 10.2147/idr.s95050] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This is a systematic review of cases with Lemierre’s syndrome (LS) in the past 5 years. LS is characterized by sepsis often evolving after a sore throat or tonsillitis and then complicated by various septic emboli and thrombosis of the internal jugular vein. Symptoms include sepsis, pain, and/or swelling in the throat or neck, as well as respiratory symptoms. Laboratory findings show elevated infectious parameters and radiological findings show thrombosis of the internal jugular vein and emboli in the lungs or other organs. The syndrome is often associated with an infection with Fusobacterium necrophorum. We found a total of 137 cases of LS, of which 47 were infected with F. necrophorum and others with Staphylococcus and Streptococcus. Complications of this rare but severe disease included osteomyelitis, meningitis, and acute respiratory distress syndrome. Mortality was extremely high in the pre-antibiotic era but has diminished with the advent of antibiotics. This review showed a mortality rate of only 2% of which none of the cases involved fusobacteria. Duration of treatment varied; a 4–6-week course of carbapenem or piperacillin/tazobactam in combination with metronidazole was optimum. Other treatment options included anticoagulants in 46% of cases, which is unwarrantedly high, as to date, no evidence of the positive effects of anticoagulants in LS exists. Only two cases had ligation of the internal jugular vein performed. This review confirms the rare, but severe aspects of LS. Mortality from LS in this day and age appears to be low, however the syndrome is difficult to recognize, and still requires the full attention of the clinician.
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Affiliation(s)
| | - Uffe Bodtger
- Department of Lung Medicine, Naestved Hospital, Naestved; Institute for Regional Health Research, University of Southern Denmark, Odense; Department of Pulmonology, Zealand University Hospital, Roskilde, Denmark
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To anticoagulate? Controversy in the management of thrombotic complications of head & neck infections. Int J Pediatr Otorhinolaryngol 2016; 88:129-35. [PMID: 27497400 DOI: 10.1016/j.ijporl.2016.06.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To review the thrombotic complications of head and neck infections, including Lemierre's syndrome, and their management. METHODS A retrospective review of pediatric patients presenting to McMaster Children's Hospital from 2009 to 2013 was undertaken. The literature was reviewed for evidence regarding the use of anticoagulation therapy in this population. RESULTS Eleven cases (6 males, 5 females) were identified. The median age was 10.9 (range 14 months-17 years). The most frequent head and neck infection causing a thrombotic complication was mastoiditis (n = 6). All had thrombi identified on imaging, with the most common location being the sigmoid sinus (n = 6) followed by the internal jugular vein (n = 5). All 11 patients were anti-coagulated with low molecular weight heparin (LMWH) within a median of 2 days of diagnosis (average duration 105.8 days). Ten patients (90.9%) had thrombus improvement or resolution within a median of 3.4 months (range 1.0-13.9). Adverse sequelae from the thrombi were MCA infarct (n = 1), septic pulmonary emboli (n = 4), cranial nerve palsies (n = 3) and Horner's syndrome (n = 2). There were no adverse effects from anti-coagulation therapy. Review of the literature revealed anticoagulant use in 63.7% of pediatric cases reported since 2002. CONCLUSION Anticoagulation remains controversial in the management of thrombotic complications from head and neck infections. Based on this case series, certain recommendations can be made regarding the benefits of anticoagulation, which appear to outweigh the risks. Further research is required to establish evidence for consensus in the antithrombotic management of thrombotic sequelae of head and neck infections.
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Udassi S, Tuli SY, Giordano BP, Udassi J. Adolescent with Fever, hypotension, and respiratory distress. J Pediatr Health Care 2015; 29:289-93. [PMID: 25115312 DOI: 10.1016/j.pedhc.2014.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 06/06/2014] [Accepted: 06/10/2014] [Indexed: 11/26/2022]
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Ben Abdallah Chabchoub R, Riquet A, Ramdane A, Vallée L, Raccoussot S. Syndrome de Lemierre révélé par un torticolis. Arch Pediatr 2015; 22:540-3. [DOI: 10.1016/j.arcped.2015.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/03/2014] [Accepted: 02/20/2015] [Indexed: 11/30/2022]
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Lemierre's Syndrome: Recognising a Typical Presentation of a Rare Condition. Case Rep Infect Dis 2015; 2015:797415. [PMID: 25692056 PMCID: PMC4323061 DOI: 10.1155/2015/797415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/07/2015] [Accepted: 01/07/2015] [Indexed: 11/29/2022] Open
Abstract
Lemierre's syndrome is a rare complication following an acute oropharyngeal infection. The aetiological agent is typically anaerobic bacteria of the genus Fusobacterium. The syndrome is characterised by a primary oropharyngeal infection followed by metastatic spread and suppurative thrombophlebitis of the internal jugular vein. If left untreated, Lemierre's syndrome carries a mortality rate of over 90%. Whilst relatively common in the preantibiotic era, the number of cases of Lemierre's syndrome subsequently declined with the introduction of antibiotics. With the increase of antibiotic resistance and a greater reluctance to prescribe antibiotics for minor conditions such as tonsillitis, there are now concerns developing about the reemergence of the condition. This increasing prevalence in the face of an unfamiliarity of clinicians with the classical features of this “forgotten disease” may result in the misdiagnosis or delay in diagnosis of this potentially fatal illness. This case report illustrates the delay in diagnosis of probable Lemierre's syndrome in a 17-year-old female, its diagnosis, and successful treatment which included the use of anticoagulation therapy. Whilst there was a positive outcome, the case highlights the need for a suspicion of this rare condition when presented with distinctive signs and symptoms.
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14-jähriger Junge mit Atemnot und Halsschmerzen. INFEKTIONSKRANKHEITEN IN DER PÄDIATRIE - 40 FALLSTUDIEN 2015. [PMCID: PMC7121983 DOI: 10.1007/978-3-662-46858-6_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pinheiro PEB, Miotto PD, Shigematsu NQ, Tamashiro E, Valera FCP, Anselmo-Lima WT. Lemierre's syndrome: a pharyngotonsillitis complication. Braz J Otorhinolaryngol 2014; 81:115-6. [PMID: 25497066 PMCID: PMC9452193 DOI: 10.1016/j.bjorl.2014.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 10/17/2014] [Indexed: 11/17/2022] Open
Affiliation(s)
- Pedro Ernesto Barbosa Pinheiro
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Priscilla Durante Miotto
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Natalia Quinhone Shigematsu
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Edwin Tamashiro
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Fabiana Cardoso Pereira Valera
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Wilma Teresinha Anselmo-Lima
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Unusual Presentation of Lemierre Syndrome. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0b013e31828d701f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
This article outlines infections in the submandibular, lateral pharyngeal, retropharyngeal, danger, and prevertebral spaces, in conjunction with infections of the sinuses and mediastinum. By understanding the anatomy and pathophysiology, the reader will gain insight into the rationale for various therapeutic options.
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Affiliation(s)
- Denise Jaworsky
- Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, British Columbia V5Z 1M9, Canada
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