Ovarian venous thrombosis during septicemia due to Fusobacterium necrophorum

Intersecting Pathologies: Vulvar Cancer Complicated by a Fusobacterium necrophorum Infection

Vulvar cancer represents a small minority of annual cancer cases in America. This malignancy affects more than the physical health of the patient. This malignancy also has a negative impact on women's psychological and sexual health. This case pertains to a 49-year-old woman (G1P1001) who presented with right groin pain, fever, and chills for three days. She reported experiencing vaginal bleeding during the intercourse and had been able to palpate a mass inside her vagina for the past five years. A pelvic exam revealed a 6 cm tender mass on the left vaginal wall, which was friable and hemorrhagic on palpation, along with associated lymphadenopathy. The patient was taken to the operating room where the exophytic mass and lymphadenopathy were biopsied. Necrotic lymph nodes were removed and sent for pathology. Pathology confirmed moderately differentiated squamous cell carcinoma of the vulva. The lymph node pathology report also indicated that the necrotic nodes were infected with Fusobacterium necrophorum. Given the extent of the tumor, it was deemed largely inoperable, and the patient was recommended local radiation therapy. The patient was diagnosed with stage III vulvar cancer. This case highlights the intersection of gynecology-oncology and infectious disease, with a never-before-documented bacterial infection in the context of vulvar cancer. Fusobacterium necrophorum has been previously associated with colorectal cancers, liver abscesses, and ovarian abscesses. Further ingestion is needed to understand the role of this pathogen in the development of vulvar cancer.

An atypical presentation of lemierre syndrome of urogenital source

Lemierre syndrome has classically been described as septic thrombophlebitis of the internal jugular veins resulting from primary oropharyngeal disease caused by Fusobacterium necrophorum. However, many cases have been reported of the syndrome originating from other primary sites of infection, resulting in limited utility of the diagnostic criteria and increased difficulty in making the diagnosis. We describe a 22-year-old female who developed the syndrome through a Fusobacterium infection which originated from a Bartholin gland abscess, a phenomenon that has not yet been described in the literature. Understanding and recognizing the variable forms of Lemierre syndrome allows us to better define the condition and provide optimal care to patients.

[Gynecological Lemierre's syndrome: A case report and literature review]

INTRODUCTION

Lemierre's syndrome is defined as an oropharyngeal infection due to Fusobacterium necrophorum, associated with septic thrombophlebitis of the internal jugular vein. The uncommon pelvic variant of the syndrome is a rare condition, poorly described in literature.

CASE REPORT

We report a case of gynecological Lemierre's syndrome in a 19-year-old woman after a first sexual intercourse, who presented acute respiratory failure, left internal iliac vein thrombosis with pulmonary embolism, in the setting of salpingitis and F. necrophorum bacteriemia.

CONCLUSION

Gynecological Lemierre's syndrome is a rare and unrecognized condition, which could be lethal. Early recognition of the disorder enables initiation of appropriate antibiotic therapy for 4 to 6 weeks, and discussion of anticoagulant therapy which indications are not yet well defined.