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Schwarz Y, Habashi N, Rosenfeld-Yehoshua N, Soikher E, Marom T, Tamir SO. Pediatric Patient with Lemierre Syndrome of the External Jugular Vein: Case Report and Literature Review. Int Arch Otorhinolaryngol 2021; 25:e633-e640. [PMID: 34737835 PMCID: PMC8558952 DOI: 10.1055/s-0040-1721337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/02/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Lemierre syndrome (LS) involving the external jugular vein (EJV) is rare, and only a few cases have been reported in the literature. Objectives To report a case of LS involving the external jugular vein as well as to make a review of the literature regarding both diagnosis and management strategies. Data Synthesis We describe a case of LS involving the EJV and review the literature of previously published articles to search for additional cases. A PubMed, Embase, Scopus, and Web of science-based search was performed to determine the scope of coverage in well-reported articles in English. Twenty-one papers were retrieved and documented for age, incidence, pathogen, presenting symptoms, imaging, treatment, and outcome, which were noted for each of these cases. In our literature review of 21 papers, there were 16 patients (61%) in their 2nd and 3rd decades of life. Lemierre syndrome was shown to affect females and males equally. The presenting symptoms were a sore throat and fever. Treatment requires intravenous antibiotics, and there is no consensus regarding treatment with anticoagulation. Conclusions The present case report and review of the literature emphasize the importance of history taking as well as physical examination in what seems to be a case of simple tonsillitis.
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Affiliation(s)
- Yehuda Schwarz
- Department of Otolaryngology Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel
| | - Nadeem Habashi
- Department of Otolaryngology Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel
| | - Noa Rosenfeld-Yehoshua
- Department of Pediatric Intensive Care Unit, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel
| | - Eugene Soikher
- Department of Radiology, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel
| | - Tal Marom
- Department of Otolaryngology Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel
| | - Sharon Ovnat Tamir
- Department of Otolaryngology Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel
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2
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An unusual case of Lemierre syndrome - One pathogen or two? IDCases 2021; 25:e01203. [PMID: 34221895 PMCID: PMC8243003 DOI: 10.1016/j.idcr.2021.e01203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/20/2021] [Accepted: 06/20/2021] [Indexed: 11/25/2022] Open
Abstract
Lemierre Syndrome is characterized by thrombophlebitis of the internal jugular vein. The disease is rare, typically preceded by pharyngitis, and is caused usually by Fusobacterium necrophorum. In rare cases, Lemierre Syndrome is polymicrobial involving other oral microbes.
Lemierre syndrome, or septic thrombophlebitis of the internal jugular vein, is a rare disease that affects healthy young adults following an episode of pharyngitis or other upper respiratory disease. It most commonly involves the anaerobe Fusobacterium necrophorum, a component of normal oral flora. In this report, we present an unusual case of polymicrobial Lemierre syndrome involving both F. necrophorum and Group C streptococcus following an episode of pharyngitis and streptococcal toxic shock syndrome. Providers should consider the possibility of polymicrobial infection when there are imaging findings suggestive of Lemierre Syndrome and adjust antibiotic regimens accordingly.
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3
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Valerio L, Zane F, Sacco C, Granziera S, Nicoletti T, Russo M, Corsi G, Holm K, Hotz MA, Righini C, Karkos PD, Mahmoudpour SH, Kucher N, Verhamme P, Di Nisio M, Centor RM, Konstantinides SV, Pecci A, Barco S. Patients with Lemierre syndrome have a high risk of new thromboembolic complications, clinical sequelae and death: an analysis of 712 cases. J Intern Med 2021; 289:325-339. [PMID: 32445216 DOI: 10.1111/joim.13114] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Lemierre syndrome is characterized by head/neck vein thrombosis and septic embolism usually complicating an acute oropharyngeal bacterial infection in adolescents and young adults. We described the course of Lemierre syndrome in the contemporary era. METHODS In our individual-level analysis of 712 patients (2000-2017), we included cases described as Lemierre syndrome if these criteria were met: (i) primary site of bacterial infection in the head/neck; (ii) objectively confirmed local thrombotic complications or septic embolism. The study outcomes were new or recurrent venous thromboembolism or peripheral septic lesions, major bleeding, all-cause death and clinical sequelae. RESULTS The median age was 21 (Q1-Q3: 17-33) years, and 295 (41%) were female. At diagnosis, acute thrombosis of head/neck veins was detected in 597 (84%) patients, septic embolism in 582 (82%) and both in 468 (80%). After diagnosis and during in-hospital follow-up, new venous thromboembolism occurred in 34 (5.2%, 95% CI 3.8-7.2%) patients, new peripheral septic lesions became evident in 76 (11.7%; 9.4-14.3%). The rate of either was lower in patients who received anticoagulation (OR: 0.59; 0.36-0.94), higher in those with initial intracranial involvement (OR: 2.35; 1.45-3.80). Major bleeding occurred in 19 patients (2.9%; 1.9-4.5%), and 26 died (4.0%; 2.7-5.8%). Clinical sequelae were reported in 65 (10.4%, 8.2-13.0%) individuals, often consisting of cranial nerve palsy (n = 24) and orthopaedic limitations (n = 19). CONCLUSIONS Patients with Lemierre syndrome were characterized by a substantial risk of new thromboembolic complications and death. This risk was higher in the presence of initial intracranial involvement. One-tenth of survivors suffered major clinical sequelae.
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Affiliation(s)
- L Valerio
- From the, Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - F Zane
- Department of General Medicine, Hospital of Sondrio, Sondrio, Italy
| | - C Sacco
- Thrombosis and Hemostasis Center, Humanitas Research Hospital and Humanitas University, Rozzano, Italy
| | - S Granziera
- Department of Physical and Rehabilitation Medicine, "Villa Salus" Hospital, Mestre, Italy
| | - T Nicoletti
- Institute of Neurology, Catholic University of the Sacred Heart and Institute of Neurology, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - M Russo
- From the, Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - G Corsi
- Department of Emergency Medicine, San Giovanni Calibita Fatebenefratelli Hospital, AFAR, Rome, Italy
| | - K Holm
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
| | - M-A Hotz
- Department of ENT, Head and Neck Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - C Righini
- Department of ENT, Head and Neck Surgery, University Hospital of Grenoble, Grenoble, France
| | - P D Karkos
- Department of Otolaryngology-Head and Neck Surgery, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S H Mahmoudpour
- From the, Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.,Institute for Medical Biostatistics, Epidemiology, and Informatics (IMBEI), Department of Biometry and Bioinformatics, University Medical Center Mainz, Mainz, Germany
| | - N Kucher
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - P Verhamme
- Department of Vascular Medicine and Hemostasis, University Hospitals Leuven, Leuven, Belgium
| | - M Di Nisio
- Department of Medicine and Ageing Sciences, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - R M Centor
- Huntsville Regional Medical Campus, University of Alabama Birmingham School of Medicine, Birmingham, AL, USA
| | - S V Konstantinides
- From the, Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.,Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - A Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - S Barco
- From the, Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.,Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
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Elhakeem IA, Al Shokri SD, Elzouki ANY, Danjuma MI. An Unusual Case of Modified Lemierre's Syndrome Caused by Staphylococcus aureus Cellulitis. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e916575. [PMID: 32008035 PMCID: PMC7017838 DOI: 10.12659/ajcr.916575] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Lemierre's syndrome is a potential life-threatening disease commonly occurring in young, healthy individuals. It is often preceded by an oropharyngeal infection causing bacteremia. This may rapidly progress into thrombophlebitis of the internal jugular venous system, its branches, and septic embolization and often fulminant organ failure. CASE REPORT A previously healthy 31-year-old male with recent history of facial herpes zoster infection, presented with 1-week history of increasingly painful nasal, and periorbital swelling. Imaging confirmed superior ophthalmic vein thrombosis. Staphylococcus aureus was isolated in blood cultures and had an uncomplicated hospital course with full recovery. CONCLUSIONS Early recognition of Lemierre's syndrome contributes significantly in reducing morbidity and mortality associated with it. Staphylococcus aureus skin infection is a very rare cause of Lemierre's syndrome, and its association with superior ophthalmic vein thrombosis has not yet been reported in literature.
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Affiliation(s)
- Israa A Elhakeem
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Abdul-Naser Y Elzouki
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar.,Department of Clinical Medicine, Qatar University, Doha, Qatar.,Weill Cornell Medicine, Doha, Qatar
| | - Mohammed I Danjuma
- Clinical Pharmacology and Therapeutics Department of General Medicine, Hamad General Hospital, Doha, Qatar.,Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
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Van Hoecke F, Lamont B, Van Leemput A, Vervaeke S. A Lemierre-like syndrome caused by Staphylococcus aureus: an emerging disease. Infect Dis (Lond) 2019; 52:143-151. [DOI: 10.1080/23744235.2019.1691255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Frederik Van Hoecke
- Department of Laboratory Medicine, Sint Andries Hospital, Tielt, Belgium
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
| | - Bart Lamont
- Department of Neurology, Sint Andries Hospital, Tielt, Belgium
| | - Ann Van Leemput
- Department of Radiology, Sint Andries Hospital, Tielt, Belgium
| | - Steven Vervaeke
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
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6
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Er C, Tey VHT, Kuthiah N, Aravamudan VM. A case of Lemierre-like Syndrome: internal jugular vein thrombosis secondary to Staphylococcus aureus sternoclavicular joint septic arthritis. Oxf Med Case Reports 2019; 2019:omz059. [PMID: 31293789 PMCID: PMC6611499 DOI: 10.1093/omcr/omz059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 11/23/2022] Open
Abstract
Lemierre syndrome is the internal jugular vein (IJV) suppurative thrombophlebitis, usually secondary to oropharyngeal infection. Staphylococcus aureus is an emerging responsible pathogen. We report a unique case of IJV thrombosis secondary to methicillin-susceptible S. aureus sternoclavicular joint septic arthritis. We review the existing literature on Lemierre syndrome: its various manifestations, causative pathogens, treatment and management.
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Affiliation(s)
- Chaozer Er
- Department of General Medicine, Woodlands Health Campus, Yishun Central, Tower E Level, Singapore
| | | | - Navin Kuthiah
- Department of General Medicine, Woodlands Health Campus, Yishun Central, Tower E Level, Singapore
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7
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Olaf M, Duguet L. Mastoiditis with concomitant Lemierre's syndrome. Am J Emerg Med 2019; 37:1214.e1-1214.e3. [PMID: 30786966 DOI: 10.1016/j.ajem.2019.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022] Open
Abstract
Otalgia with mastoiditis is an infrequently encountered complication of acute otitis media (Pfaff and Moore, 2018). Even more rare is the development of infected jugular venous thrombosis, Lemierre's disease. We present a case of a six year-old girl with otalgia for over two months who presented to our Emergency Department (ED) with clinical mastoiditis, confirmed on CT scan, as well as an incidental diagnosis of complete thrombosis of the internal jugular (IJ) vein, Lemierre's syndrome. The true prevalence of Lemierre's from mastoiditis is difficult to discern. This clinical case highlights the importance of the consideration of these pathologies by the emergency physician.
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Affiliation(s)
- Mark Olaf
- Department of Emergency Medicine, Geisinger Health System, 100 North Academy Ave., Danville, PA 17822-2005, USA.
| | - Lindsey Duguet
- Department of Emergency Medicine, Geisinger Health System, 100 North Academy Ave., Danville, PA 17822-2005, USA
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8
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Rafati F, Bhalla V, Chillal V, Thyagarajan M. Lemierre syndrome: a diagnostic dilemma in paediatric patients. J Surg Case Rep 2017; 2017:rjx210. [PMID: 29302305 PMCID: PMC5739045 DOI: 10.1093/jscr/rjx210] [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: 08/09/2017] [Revised: 09/26/2017] [Accepted: 10/13/2017] [Indexed: 01/25/2023] Open
Abstract
Lemierre’s syndrome is a rare disease of the head and neck, characterized by an initial infection, usually within the oropharynx, which can develop into a septic thrombophlebitis. It can involve the jugular vein, facial veins and respiratory tract. A 7-year-old child attended our institution with a 1-week history of fever and cough. Initial imaging demonstrated a large left sided empyema with multiple cavitating lung lesions and persisting pneumothoraces secondary to the development of a bronchopleural fistula. There was no clinical improvement, despite an initial course of antibiotics. A contrast enhanced computed tomography (CT) of the head and neck revealed left mastoiditis, multiple cerebral abscesses and thrombus within the left internal jugular vein. Antibiotic therapy was modified. The empyema was surgically drained and bronchopleural fistula repaired. This case illustrates an atypical presentation of Lemierre’s syndrome in a child, with respiratory complications secondary to septic emboli.
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Affiliation(s)
- Fatemeh Rafati
- Department of Imaging, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Vishal Bhalla
- Department of Imaging, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
- Correspondence address. Imaging department, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK. Tel: +44-0121-333-9999; Fax: +44-0121-766-6919; E-mail:
| | - Varun Chillal
- Department of Imaging, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Mani Thyagarajan
- Department of Imaging, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
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9
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Tong SYC, Davis JS, Eichenberger E, Holland TL, Fowler VG. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 2015; 28:603-61. [PMID: 26016486 PMCID: PMC4451395 DOI: 10.1128/cmr.00134-14] [Citation(s) in RCA: 2733] [Impact Index Per Article: 303.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections. It is a leading cause of bacteremia and infective endocarditis as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device-related infections. This review comprehensively covers the epidemiology, pathophysiology, clinical manifestations, and management of each of these clinical entities. The past 2 decades have witnessed two clear shifts in the epidemiology of S. aureus infections: first, a growing number of health care-associated infections, particularly seen in infective endocarditis and prosthetic device infections, and second, an epidemic of community-associated skin and soft tissue infections driven by strains with certain virulence factors and resistance to β-lactam antibiotics. In reviewing the literature to support management strategies for these clinical manifestations, we also highlight the paucity of high-quality evidence for many key clinical questions.
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Affiliation(s)
- Steven Y C Tong
- Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Joshua S Davis
- Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Emily Eichenberger
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Thomas L Holland
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
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10
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Gibelin A, Contou D, Labbé V, Parrot A, Djibré M, Fartoukh M. Acute respiratory distress syndrome in a young soccer player: search obturator internus primary pyomyositis. A reverse Lemierre syndrome. Am J Emerg Med 2014; 33:740.e5-6. [PMID: 25498532 DOI: 10.1016/j.ajem.2014.11.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/18/2014] [Indexed: 11/26/2022] Open
Affiliation(s)
- Aude Gibelin
- Service de Pneumologie et Réanimation. Hôpital Tenon, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie, 4 Rue de la Chine, 75020 Paris, France.
| | - Damien Contou
- Service de Pneumologie et Réanimation. Hôpital Tenon, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie, 4 Rue de la Chine, 75020 Paris, France.
| | - Vincent Labbé
- Service de Pneumologie et Réanimation. Hôpital Tenon, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie, 4 Rue de la Chine, 75020 Paris, France.
| | - Antoine Parrot
- Service de Pneumologie et Réanimation. Hôpital Tenon, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie, 4 Rue de la Chine, 75020 Paris, France.
| | - Michel Djibré
- Service de Pneumologie et Réanimation. Hôpital Tenon, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie, 4 Rue de la Chine, 75020 Paris, France.
| | - Muriel Fartoukh
- Service de Pneumologie et Réanimation. Hôpital Tenon, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie, 4 Rue de la Chine, 75020 Paris, France.
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11
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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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12
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Kumar M, Singh R, Sawlani KK, Kumar S. Atypical presentation of Lemierre syndrome: role of imaging. BMJ Case Rep 2013; 2013:bcr-2012-007647. [PMID: 23345481 DOI: 10.1136/bcr-2012-007647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 51-year-old male patient presented with breathlessness for 10 days. Chest radiograph revealed bilateral moderate pleural effusion. Ultrasound-guided diagnostic pleural aspirate revealed sterile transudative fluid. CT thorax revealed bilateral moderate pleural effusion with partial collapse of both lower lobes and thrombus in right brachiocephalic vein. Two-dimensional-echo revealed circumferential pericardial effusion with mild pericardial thickening and moderate tricuspid regurgitation. Cardiolipin antibodies were within normal limits. d-Dimer assay and C reactive protein were markedly raised. During the period of investigations, the patient had developed mild swelling and pain in right upper limb for which colour Doppler ultrasonography of his right upper limb and neck regions were done. Thrombi in right internal jugular, subclavian and brachiocephalic veins were noted. CT angiography, CT abdomen and chest confirmed the above findings. However, extent of the thrombus and lung lesions was better delineated by CT angiography. We have highlighted the pathognomonic imaging findings of Lemierre syndrome.
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Affiliation(s)
- Manoj Kumar
- Department of Radiodiagnosis, King George's Medical University, Lucknow, Uttar Pradesh, India.
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Pitsiou G, Kachrimanidou M, Papa A, Kioumis I, Paspala A, Boutou A, Vlachou S, Tsorlini E, Argyropoulou-Pataka P. Lemierre's syndrome presenting to the ED: rapidly fatal sepsis caused by methicillin-susceptible Staphylococcus aureus Staphylococcus protein A type t044. Am J Emerg Med 2012; 31:268.e5-7. [PMID: 22795989 DOI: 10.1016/j.ajem.2012.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 04/17/2012] [Indexed: 10/28/2022] Open
Abstract
We describe the case of a fatal septic illness in a previously healthy young man caused by community-acquired methicillin-susceptible Staphylococcus aureus of Staphylococcus protein A (spa) type t044. The patient developed a devastating Lemierre-like syndrome with extensive thrombosis of inferior vena cava and iliac veins with multiple metastatic septic emboli of the lungs. He presented to the emergency department with rapidly progressing sepsis followed by multiple organ dysfunction syndrome. Recognition of such virulent community-acquired strains is of great importance because they could prove to be emerging pathogens for life-threatening diseases.
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Affiliation(s)
- Georgia Pitsiou
- Respiratory Failure Unit, Aristotle University of Thessaloniki, G.H. G. Papanikolaou, Exohi, Thessaloniki, 57010, Greece.
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14
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The changing face of an old disease: case report of nonclassical Lemierre's syndrome caused by a Panton-Valentine leucocidin-positive methicillin-susceptible Staphylococcus aureus isolate. J Clin Microbiol 2012; 50:3144-5. [PMID: 22760040 DOI: 10.1128/jcm.00939-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Methicillin-resistant Staphylococcus aureus USA300 clone as a cause of Lemierre's syndrome. J Clin Microbiol 2011; 49:2063-6. [PMID: 21430106 DOI: 10.1128/jcm.02507-10] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe a case of a young woman who had methicillin-resistant Staphylococcus aureus USA300 clone (MRSA-USA300)-associated Lemierre's syndrome and secondary necrotizing pneumonia and cerebral infarcts. We also review 11 cases of S. aureus-associated Lemierre's syndrome reported in the literature from 1965 to 2010. Recognition of S. aureus as an emergent cause of Lemierre's syndrome informs the initial empirical antibiotic choice for this life-threatening condition and may positively impact patient outcomes.
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16
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Yoshikawa H, Suzuki M, Nemoto N, Hara H, Hashimoto G, Otsuka T, Moroi M, Nakamura M, Sugi K. Internal jugular thrombophlebitis caused by dermal infection. Intern Med 2011; 50:447-50. [PMID: 21372456 DOI: 10.2169/internalmedicine.50.4612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 29-year-old man presented with complaints of fever and pain and itching of his left neck with atopic dermatitis and abrasion. These symptoms had persisted for two days and dullness and fever developed, but the patient did not consult a physician. On the following day, he had a fever of 40°C and redness and swelling of the left neck. He visited a local clinic and was hospitalized with suspected cellulitis. A thrombus was detected in the internal jugular vein on MRI, and he was referred to our hospital. Neck ultrasonography showed the presence of an immovable thrombus in the area from the left internal jugular vein to the left brachiocephalic peripheral vein. Blood analysis indicated a major inflammatory response and juvenile idiopathic thrombophlebitis was suspected. A filter was carefully inserted into the superior vena cava, and anticoagulant therapy and medication with antibiotics led to remission. We present this case as a rare example of a condition mimicking Lemierre syndrome that was caused by dermal infection, and we include a review of the literature.
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Affiliation(s)
- Hisao Yoshikawa
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Japan.
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