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Au PH, Nwabara K, Gvazava N, Ejiofor S, Ghous G. Lemierre Syndrome: A Diagnosis behind the Veil. Case Rep Infect Dis 2023; 2023:2273954. [PMID: 37113164 PMCID: PMC10129419 DOI: 10.1155/2023/2273954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/26/2023] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Abstract
Lemierre syndrome (LS) is a rare, serious infection that is often misdiagnosed, as it frequently mimics common upper respiratory infections. It is even rarer for LS to be preceded by a viral infection. We share a case of LS in a young man who presented to the Emergency Department with COVID-19 viral infection followed by a subsequent LS diagnosis. The patient's condition initially worsened despite treatments for COVID-19 and was subsequently started on broad-spectrum antibiotics. He was then diagnosed with LS after blood cultures grew Fusobacterium necrophorum, and antibiotics were adjusted accordingly, resulting in improvement of symptoms. Even though LS is often recognized as a sequela of bacterial pharyngitis, preceding viral infections, including COVID-19, might be a risk factor that contributes to the development of LS.
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Affiliation(s)
- Pak-Ho Au
- University Hospital, University of Missouri, Columbia, Missouri, USA
| | - Kelechi Nwabara
- University Hospital, University of Missouri, Columbia, Missouri, USA
| | - Nanuli Gvazava
- University Hospital, University of Missouri, Columbia, Missouri, USA
| | - Shannon Ejiofor
- University Hospital, University of Missouri, Columbia, Missouri, USA
| | - Ghulam Ghous
- Ellis Fischel Cancer Center, University of Missouri, Columbia, Missouri, USA
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Gohal SO, Alsubhi IM, Alharbi EA, Alkhalaf HE, Alnefaie BH, Althomali RA, Hasan BA, Alsadi MA, Alamri AH, Alharbi AA, Almanea MY, Almarshood FS, Almoallem SA, Albogami AF, Al-Hawaj F. Lemierre's Syndrome: A Case of Life-Threatening Infection From Family Medicine Practice. Cureus 2021; 13:e20684. [PMID: 35106224 PMCID: PMC8785805 DOI: 10.7759/cureus.20684] [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] [Accepted: 12/25/2021] [Indexed: 11/17/2022] Open
Abstract
The use of antibiotic therapy has led to a major transformation in medicine with a substantial reduction in mortality. Due to the adverse effects associated with inappropriate antibiotic use, antibiotic stewardship interventions have been promoted to improve antibiotic prescription. However, delayed antibiotic therapy, when clinically needed, may result in increased morbidity. Here, we report the case of a previously healthy young man with an untreated acute upper respiratory infection for two weeks, who presented with headache and fever. Physical examination suggested meningitis as evident by neck stiffness and positive Kernig sign. Purulent tonsilitis was also noted. Laboratory findings showed leukocytosis and elevated inflammatory markers. The patient underwent a computed tomography scan to rule out space-occupying lesions prior to lumbar puncture. The scan revealed thrombophlebitis of the left internal jugular vein that extended to the dural venous sinuses. Magnetic resonance imaging confirmed the intracranial dissemination of the disease. Such findings conferred the diagnosis of Lemierre's syndrome. The patient was admitted to the intensive care unit where he received systemic anticoagulation and prolonged intravenous antibiotics. He developed a good response and was discharged with no residual deficits after six weeks of hospitalization. Lemierre's syndrome is a serious infection that develops after a pharyngeal infection. Considering the high mortality rate of untreated Lemierre's syndrome, physicians should keep a high index of suspicion for this condition when they encounter a patient with upper respiratory tract infection with clinical or radiological findings consistent with internal jugular thrombophlebitis.
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Affiliation(s)
- Sultan O Gohal
- College of Medicine, Batterjee Medical College, Jeddah, SAU
| | - Ishtiyaq M Alsubhi
- Department of General Practice, King Salman Specialist Hospital, Hail, SAU
| | - Essa A Alharbi
- College of Medicine, Northern Border University, Arar, SAU
| | | | - Bandar H Alnefaie
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | - Bayan A Hasan
- College of Medicine, Arabian Gulf University, Manama, BHR
| | - Mada A Alsadi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Assaf H Alamri
- College of Medicine, Jordan University of Science and Technology, Irbid, JOR
| | | | | | | | | | | | - Faisal Al-Hawaj
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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Ouyang JX, Kim EE, Manaloor JJ. Abnormal Eye Movement in a 5-year-old Girl. Pediatr Rev 2021; 42:389-392. [PMID: 34210759 DOI: 10.1542/pir.2020-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - John J Manaloor
- Riley Hospital for Children, Indianapolis, IN.,Ryan White Center for Pediatric Infectious Diseases and Global Health, Indianapolis, IN
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Mariniello G, Corvino S, Teodonno G, Pagano S, Maiuri F. Postoperative Lemierre’s syndrome: a previously unreported complication of transoral surgery. Illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE20118. [PMID: 35855218 PMCID: PMC9245783 DOI: 10.3171/case20118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/17/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Lemierre’s syndrome is a rare but potentially life-threatening clinical condition characterized by bacteremia and thrombophlebitis of the internal jugular vein, usually secondary to oropharyngeal infection and often caused by Fusobacterium necrophorum; rarely, it occurs after surgical procedures. The most common clinical presentation includes acute pharyngitis, high fever, and neck pain. The diagnosis is based on blood culture and cranial and cervical spine computed tomography (CT)/magnetic resonance imaging (MRI) with contrast. Antibiotic therapy for 3–6 weeks is the mainstay of treatment, while the use of anticoagulant drugs is controversial.
OBSERVATIONS
The authors describe a case of Lemierre’s syndrome that occurred after transoral surgery. The patient underwent a combined surgical approach from above (transoral) and below (anterolateral transcervical) to the upper cervical spine for the resection of a large anterior osteophyte causing dysphagia, globus sensation, and dysphonia. Three weeks after the surgical procedure, she developed fever and severe neck pain.
LESSONS
The aim of this paper is to consider Lemierre’s syndrome as a possible complication after the transoral approach, underlining the importance of its early diagnosis and with a suggestion to perform cranial and cervical spine CT or MRI venous angiography in patients who undergo surgery with a transoral approach and exhibit local or systemic signs of infection such as neck pain, persistent fever, and positive blood culture results.
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B K A, Gilotra T, Tymko C, Siddique Z, Eranki A. A Rare Case of Lemierre's Syndrome Caused by Streptococcus Intermedius, Presenting as an Epidural Abscess. Cureus 2020; 12:e7787. [PMID: 32455086 PMCID: PMC7243612 DOI: 10.7759/cureus.7787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Lemierre's syndrome is a rare but life-threatening condition characterized by an oropharyngeal infection typically secondary to Fusobacterium necrophorum resulting in septic thrombophlebitis of the internal jugular vein. Streptococcus intermedius is a particularly rare cause of Lemierre's syndrome with only a few cases reported in the literature. Here we describe a rare case of Lemierre's syndrome, caused by Streptococcus intermedius, likely secondary to an odontogenic infection, found to have a cervical epidural abscess with concomitant large retropharyngeal and prevertebral abscesses on presentation, in whom the clinical course was further complicated by an extensive cerebral venous sinus thrombosis. However, despite grave complications, early diagnosis and appropriate emergency management including intravenous antibiotics and surgical intervention led to a successful recovery, thus demonstrating that aggressive measures can potentially lead to a favorable outcome.
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Affiliation(s)
- Anupama B K
- Internal Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
| | - Tarvinder Gilotra
- Infectious Disease, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
| | - Casey Tymko
- Anesthesiology, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
| | - Zaid Siddique
- Radiology, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
| | - Ambika Eranki
- Infectious Disease, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
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Deep neck space infection and Lemierre's syndrome caused by Streptococcus anginosus: A case report. IDCases 2020; 19:e00669. [PMID: 32226760 PMCID: PMC7093741 DOI: 10.1016/j.idcr.2019.e00669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction Deep neck space infections most commonly arise from a septic focus of the mandibular teeth, tonsils, parotid gland, middle ear or sinuses, usually with a rapid onset and frequently with progression to life-threatening complications. Lemierre’s syndrome is classically defined by an oropharyngeal infection with internal jugular vein thrombosis followed by metastatic infections in other organs. Case presentation A 32-year-old female patient, with no significant past medical history, was diagnosed with a dental abscess on her left inferior 3rd molar. Six days later, the condition complicated with severe upper respiratory distress, odynophagia and trismus, and extension of the inflammatory signs to the anterior cervical region, involving the upper airway. Computed tomography scan confirmed extension to submandibular, parapharyngeal and retrosternal spaces), which required nasotracheal intubation due to compromised airway. Urgent and subsequent surgical drainages were performed, alongside with concomitant antibiotic therapy. Additionally, left internal jugular vein thrombosis was described - with later extension to the brachiocephalic vein, without other complications, consistent with Lemierre's syndrome, although without full features. Streptococcus anginosus was identified in the drained pus specimens. The patient made a satisfactory clinical progress and was discharged after 25 days, still under therapeutic hypocoagulation. Conclusion As deep neck space infections can be life-threatening, clinicians must be aware and not underestimate their potential severity. Lemierre's syndrome is a complication difficult to recognize, which requires additional awareness of the many possible presentations, for appropriate diagnostic studies and therapeutic plan.
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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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Sabaka P, Kachlíková M, Bendžala M, Káčerová H. Lemierre syndrome caused by Klebsiella pneumoniae complicated by epidural abscess - Case report. IDCases 2019; 19:e00664. [PMID: 32226757 PMCID: PMC7093747 DOI: 10.1016/j.idcr.2019.e00664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 11/02/2019] [Accepted: 11/02/2019] [Indexed: 02/08/2023] Open
Abstract
Klebsiella pneumoniae is an extremely rare case of the Lemierre syndrome, which is characterized as septic thrombophlebitis of the jugular vein as a consequence of oropharyngeal infection. We present a unique case of Lemierre syndrome caused by Klebsiella pneumoniae, complicated by epidural abscess. The patient presented with fever, severe nuchal pain and stiffness and mild sore throat and headache. Computed tomography revealed a neck abscess localized dorsally to a left mandibular ramus and continuing caudally along the sternocleidomastoid muscle, thrombosis of the left internal jugular vein and fluid collection in the epidural space. Viewed under magnetic resonance imagining, the effusion had the character of an epidural abscess. Cultivation of oropharyngeal swab and blood cultures revealed Klebsiella pneumoniae. The neck abscess was surgically drained, and the patient was treated with a combination of parenteral antimicrobials until complete clinical and radiologic remission. This case highlights the importance of also covering the gram-negative facultative anaerobic rod spectrum in the empiric antimicrobial treatment of Lemierre syndrome.
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Affiliation(s)
- Peter Sabaka
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, Limbova 5, 831 01, Slovak Republic
| | - Mária Kachlíková
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, Limbova 5, 831 01, Slovak Republic
| | - Matej Bendžala
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, Limbova 5, 831 01, Slovak Republic
| | - Helena Káčerová
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, Limbova 5, 831 01, Slovak Republic
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