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El Hajra I, Llop E, Blanco S, Perelló C, Fernández-Carrillo C, Calleja JL. Portal Vein Thrombosis in COVID-19: An Underdiagnosed Disease? J Clin Med 2024; 13:5599. [PMID: 39337086 PMCID: PMC11433429 DOI: 10.3390/jcm13185599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 09/18/2024] [Accepted: 09/19/2024] [Indexed: 09/30/2024] Open
Abstract
Background: Multiple studies have linked COVID-19 to a higher incidence of thromboembolic disorders. However, the association of COVID-19 with other potentially life-threatening complications, such as splanchnic vein thrombosis, is less well understood. This study aims to assess the prevalence, patient characteristics, clinical presentation, and outcomes of patients with portal vein thrombosis (PVT) and COVID-19. Methods: This was a retrospective observational study. From all positive patients for a reverse-transcription polymerase chain reaction (RT-PCR) swab test from March 2020 to June 2020, we included those who were older than 18 years, had received abdominal contrast-enhanced computed tomography (CT) in the 6 months following the positive RT-PCR swab, and had no previously known splanchnic vein thrombosis. Results: A total of 60 patients with abdominal CT were selected from all those positive for SARS-CoV-2 (n = 2987). The prevalence of PVT was 3/60 (5%). The mean age was 66.1 ± 16.5 years and 51.7% were male. In two of the three patients, there was no underlying pathology as a risk factor for PVT and one of them presented cirrhosis. The number of days from the start of COVID-19 symptoms until the PVT diagnosis were 21, 12, and 10 days. Anticoagulation treatment achieved recanalization in 100% of cases. During a mean follow-up of 803 days, none of the patients experienced long-term complications. Conclusions: Portal vein thrombosis is uncommon, and its incidence may be higher in COVID-19 patients. A greater understanding of the features of this disease in the context of COVID-19 could aid towards its diagnosis and allow for early detection and management.
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Affiliation(s)
- Ismael El Hajra
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain
| | - Elba Llop
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain
- Instituto de Investigación Sanitaria Puerta Hierro-Segovia Arana (IDIPHISA) Majadahonda, 28222 Madrid, Spain
- Centro de Investigación Biomédica en Red (CIBEREHD), 28029 Madrid, Spain
| | - Santiago Blanco
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain
| | - Christie Perelló
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain
- Instituto de Investigación Sanitaria Puerta Hierro-Segovia Arana (IDIPHISA) Majadahonda, 28222 Madrid, Spain
- Centro de Investigación Biomédica en Red (CIBEREHD), 28029 Madrid, Spain
| | - Carlos Fernández-Carrillo
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain
- Instituto de Investigación Sanitaria Puerta Hierro-Segovia Arana (IDIPHISA) Majadahonda, 28222 Madrid, Spain
- Centro de Investigación Biomédica en Red (CIBEREHD), 28029 Madrid, Spain
| | - José Luis Calleja
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain
- Instituto de Investigación Sanitaria Puerta Hierro-Segovia Arana (IDIPHISA) Majadahonda, 28222 Madrid, Spain
- Centro de Investigación Biomédica en Red (CIBEREHD), 28029 Madrid, Spain
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2
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Miyamori D, Shigemoto N, Une K, Kinoshita H, Harimoto S, Sakashita T, Ito M. Delayed onset septic pelvic thrombophlebitis treated by tissue-plasminogen activator following initial treatment for massive right ovarian vein thrombosis and methicillin-resistant Staphylococcus aureus bacteremia: A case report. J Obstet Gynaecol Res 2024; 50:1408-1414. [PMID: 38807344 DOI: 10.1111/jog.15991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/16/2024] [Indexed: 05/30/2024]
Abstract
Septic pelvic thrombophlebitis (SPT) is a rare condition that forms thrombosis in the pelvic veins, typically the ovarian veins, with subsequent infection and inflammation. We present a case of right ovarian vein thrombosis (ROVT), methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, and delayed onset of SPT symptoms, requiring tissue-plasminogen activator. A 40-year-old woman, G3P2, at 38 weeks' gestation, was admitted with a fever of 39°C. She had cervical insufficiency and had been often on bed rest. Blood culture revealed MRSA and computed tomography revealed a large ROVT. She received vancomycin and direct oral anticoagulant, and her fever resolved by day 3. On day 16, fever recurred with severe pain over the ROVT. Second computed tomography showed thickening of venous wall with enhancement around ROVT, consistent with SPT. Since pain and fever gradually exacerbated despite treatment with DOAC and antimicrobials, she was started on heparin and tissue plasminogen activator on days 23 and 25, respectively. Along with recanalization on the thrombosis by day 29, fever and abdominal pain resolved. We experienced a case of delayed onset SPT associated with MRSA bacteremia and a large ROVT. MRSA bacteremia might cause the originally existing ROVT to become an infection source, resulting in SPT with recurrent symptoms and long-term treatment. Early and strict anticoagulation is crucial in cases with a large thrombosis and bacteremia, due to the high risk of progression to SPT. This case highlights the importance of recanalization for the treatment of SPT and usefulness of administration of tissue-plasminogen activator for the massive thrombosis.
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Affiliation(s)
- Daisuke Miyamori
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima-shi, Hiroshima-ken, Japan
- Department of Emergency Medicine, JA Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Norifumi Shigemoto
- Department of Infectious Disease, Hiroshima University Hospital, Hiroshima-shi, Hiroshima-ken, Japan
| | - Kazunobu Une
- Department of Emergency Medicine, JA Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Hiroki Kinoshita
- Department of Cardiology, JA Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Shina Harimoto
- Department of Gynecology, Miyoshi Central Hospital, Miyoshi, Hiroshima, Japan
| | - Tomohisa Sakashita
- Department of Gynecology, JA Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Masanori Ito
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima-shi, Hiroshima-ken, Japan
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3
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Custo S, Tabone E, Aquilina A, Gatt A, Riva N. Splanchnic Vein Thrombosis: The State-of-the-Art on Anticoagulant Treatment. Hamostaseologie 2024; 44:242-254. [PMID: 38354834 DOI: 10.1055/a-2232-5480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Splanchnic vein thrombosis (SVT) is a rare type of venous thromboembolism occurring within the splanchnic venous system. Portal vein thrombosis is the most common presentation, while Budd-Chiari syndrome is the least common. Liver cirrhosis and abdominal solid cancer are the main local risk factors for SVT, whereas myeloproliferative neoplasms are the predominant systemic risk factors. Signs and symptoms of SVT are nonspecific and include abdominal pain, gastrointestinal bleeding, and ascites. Asymptomatic SVT is not uncommon, and the majority would be detected incidentally on routine abdominal imaging performed for the follow-up of liver diseases and tumors. The management of SVT aims to prevent thrombus progression, promote vessel recanalization, and prevent recurrent venous thromboembolism. Anticoagulation should be started early in order to increase the chances of vessel recanalization and reduce the risk of portal hypertension-related complications. Direct oral anticoagulants have been included in recent guidelines, as alternatives to vitamin K antagonists, after clinical stability has been reached; however, caution is required in patients with liver or kidney dysfunction. Treatment duration is based on the presence (or absence) and type (transient vs. permanent) of risk factors. This narrative review aims to summarize the latest evidence on SVT, with a particular focus on the anticoagulant treatment in special categories of patients (e.g., liver cirrhosis, solid cancer, myeloproliferative neoplasms, pancreatitis, incidentally detected SVT, Budd-Chiari syndrome, and chronic SVT).
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Affiliation(s)
- Scott Custo
- Medical School, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Emma Tabone
- Medical School, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Alexia Aquilina
- Medical School, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Alex Gatt
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Nicoletta Riva
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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4
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Christoforou P, Constantinou C, Kounnos C, Kapoulas K, Salloumis M, Pantelas G, Hadjihannas L. A Rare and Dangerous Combination of COVID-19, Lemierre Syndrome, and Carotid Pseudoaneurysm: A Case Report. Vasc Specialist Int 2024; 40:22. [PMID: 38915225 PMCID: PMC11196942 DOI: 10.5758/vsi.240025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/28/2024] [Accepted: 05/10/2024] [Indexed: 06/26/2024] Open
Abstract
Lemierre syndrome is a rare complication of oropharyngeal infection that causes septic thrombophlebitis in the internal jugular vein. Since the onset of the COVID-19 pandemic, this condition has been dangerously overlooked and poses an even greater threat when complicated by vascular pathologies. A case is presented where the patient required emergency endovascular exclusion of a right internal carotid artery pseudoaneurysm due to Lemierre syndrome. The treatment included stent graft placement and drainage of a neck abscess, along with appropriate antibiotic treatment during hospitalization. Recognizing this diagnosis requires a high index of suspicion, particularly during the COVID-19 pandemic. The complexity of the disease necessitates extensive multidisciplinary collaboration for effective treatment.
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Affiliation(s)
| | - Costas Constantinou
- Infectious Diseases Unit, Department of Internal Medicine, Nicosia General Hospital, Nicosia, Cyprus
| | - Christos Kounnos
- Vascular and Endovascular Clinic, Nicosia General Hospital, Nicosia, Cyprus
| | | | - Marios Salloumis
- Oral and Maxillofacial Surgery Clinic, Nicosia General Hospital, Nicosia, Cyprus
| | - Georgios Pantelas
- Oral and Maxillofacial Surgery Clinic, Nicosia General Hospital, Nicosia, Cyprus
| | - Linos Hadjihannas
- Infectious Diseases Unit, Department of Internal Medicine, Nicosia General Hospital, Nicosia, Cyprus
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5
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Simsek B, Zhang R, Morton C, Villanueva MS. Lemierre syndrome with pulmonary empyema caused by Prevotella intermedia. BMJ Case Rep 2024; 17:e258158. [PMID: 38490705 PMCID: PMC10946344 DOI: 10.1136/bcr-2023-258158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
Lemierre syndrome is a rare disease that is most often caused by Fusobacterium necrophorum We present a case caused by Prevotella intermedia in a young, healthy man, complicated by multiple cavitary lung lesions, loculated pleural effusions requiring chest tube placement and trapezius abscess. Our case highlights (a) P. intermedia as a rare cause of Lemierre syndrome and (b) clinical response to appropriate antimicrobial therapy may be protracted.
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Affiliation(s)
- Bahadir Simsek
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Renee Zhang
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christopher Morton
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Merceditas S Villanueva
- Department of Internal Medicine, Section of Infectious Disease, Yale University School of Medicine, New Haven, Connecticut, USA
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6
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Hapshy V, Imburgio S, Sanekommu H, Nightingale B, Taj S, Hossain MA, Patel S. Pylephlebitis-induced acute liver failure: A case report and review of literature. World J Hepatol 2024; 16:103-108. [PMID: 38313245 PMCID: PMC10835482 DOI: 10.4254/wjh.v16.i1.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/24/2023] [Accepted: 12/12/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Pylephlebitis is an extremely rare form of septic thrombophlebitis involving the portal vein, carrying high rates of morbidity and mortality. CASE SUMMARY We present a case of a 42-year-old male with no past medical history who presented with acute onset of abdominal pain and altered mental status with laboratory tests demonstrating new-onset acute liver failure. Pylephlebitis was determined to be the underlying etiology due to subsequent workup revealing polymicrobial gram-negative anaerobic bacteremia and complete thrombosis of the main and left portal veins. To our knowledge, this is the first documented case of acute liver failure as a potential life-threatening complication of pylephlebitis. CONCLUSION Our case highlights the importance of considering pylephlebitis in the broad differential for abdominal pain, especially if there are co-existing risk factors for hypercoagulability. We also demonstrate that fulminant hepatic failure in these patients can potentially be reversible with the immediate initiation of antibiotics and anticoagulation.
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Affiliation(s)
- Vera Hapshy
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, United States.
| | - Steven Imburgio
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, United States
| | - Harshavardhan Sanekommu
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, United States
| | - Brandon Nightingale
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, United States
| | - Sobaan Taj
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, United States
| | - Mohammad A Hossain
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, United States
| | - Swapnil Patel
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, United States
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7
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Salam R, Verma A, Noeske M, Alnimer L, Sieloff EM, Piper MS. Gastrointestinal Variant of Lemierre Syndrome due to Fusobacterium nucleatum: A Case Report. Case Rep Gastroenterol 2024; 18:144-152. [PMID: 38501151 PMCID: PMC10948173 DOI: 10.1159/000536619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 01/29/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction Pyogenic liver abscess is a noteworthy health concern in North America, characterized by a mortality rate ranging from 2 to 12%. This condition is often polymicrobial, with Streptococcus species and Escherichia coli as the predominant causal pathogens in Western countries. Fusobacterium species, typically commensals of gastrointestinal, genital, and oral flora, have been implicated in the rare formation of tonsillar abscesses and Lemierre syndrome, including its gastrointestinal variant known as pylephlebitis. Case Presentation We present the case of an immunocompetent male with a 2-week history of abdominal distention and pain. Abdominal magnetic resonance imaging revealed multiseptated cystic hepatic masses and portal vein thrombosis. A subsequent liver biopsy confirmed Fusobacterium nucleatum etiology. The patient was initiated on intravenous cefepime and oral metronidazole antibiotics. Unfortunately, the patient succumbed to cardiac arrest before a final diagnosis could be established. Conclusion Fusobacterium species-associated liver abscess, coupled with the rare gastrointestinal variant of Lemierre syndrome (pylephlebitis), poses a significant mortality risk. This case underscores the rarity and clinical challenges associated with these conditions. Increased awareness among clinicians is crucial for early diagnosis and prompt intervention, potentially improving outcomes in such cases.
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Affiliation(s)
- Reshad Salam
- Department of Internal Medicine, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Abhiroop Verma
- Department of Internal Medicine, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Michael Noeske
- Division of Radiology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Lynna Alnimer
- Department of Internal Medicine, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Eric M. Sieloff
- Division of Gastroenterology, Department of Internal Medicine, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Marc S. Piper
- Division of Gastroenterology, Department of Internal Medicine, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
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8
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Abstract
Septic pulmonary embolism (SPE) is a rare clinical entity that is distinct from the classic and more common non-septic thrombotic pulmonary embolism. SPE should be suspected in patients with a systemic acute inflammatory reaction or sepsis who develop signs and symptoms of pulmonary involvement. The diagnosis of SPE depends on the specific radiologic finding of multiple, peripheral, nodular, possibly cavitated lesions. SPE should prompt an immediate search for the primary source of infection; typically, right-sided infective endocarditis, cardiac implantable electronic devices, and septic thrombophlebitis as a complication of bone, skin, and soft tissue infection including Lemierre's syndrome, indwelling catheters, or direct inoculation via injection drug use. Invasive treatment of the infection source may be necessary; in thrombophlebitis, the efficacy and safety of anticoagulation remain undefined. Blood cultures may be negative, particularly among patients with recent antibiotic exposure, and broad-spectrum antimicrobial therapy should be considered. The in-hospital mortality of SPE ranges up to 20% in published case series. While trends in the incidence of SPE are unknown, the opioid epidemic, the growing use of cardiac implantable electronic devices worldwide, and the reported increase in cases of septic thrombophlebitis may be leading to an escalation in SPE cases. We provide a contemporary profile of SPE and propose a clinical management algorithm in patients with suspected or confirmed SPE.
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Affiliation(s)
- Luca Valerio
- Center for Thrombosis and Hemostasis, University Medical Center at the Johannes Gutenberg University, Mainz, Germany
- Department of Cardiology, University Medical Center at the Johannes Gutenberg University, Mainz, Germany
| | - Larry M Baddour
- Departments of Medicine and Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Division of Public Health, Infectious Diseases and Occupational Health, Rochester, Minnesota
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Elmeazawy R, El Amrousy D. Baseline characteristics and analysis of predictors of the Outcome of septic pulmonary embolism in children: a retrospective observational study. BMC Pediatr 2023; 23:215. [PMID: 37147610 PMCID: PMC10161177 DOI: 10.1186/s12887-023-03998-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 04/07/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Septic pulmonary embolism is a rare disease in children. We aimed to assess the clinical, microbiological, and radiological characteristics and outcomes of pediatric septic pulmonary embolism (SPE) and to identify any predictive factors for in-hospital mortality in patients with this unusual disease to enhance prognosis and treatment. METHODS A retrospective study to search the electronic medical records of children admitted to the pediatric pulmonology unit, Tanta University hospital with the diagnosis of SPE between January 2015 and June 2022. RESULTS Seventeen pediatric patients were identified; ten males and seven females with a mean age of 9.4 ± 5.2 years. The most common presenting complaints were fever and shortness of breath (n = 17) followed by chest pain (n = 9), pallor (n = 5), limb swelling (n = 4), and back pain (n = 1). Methicillin-resistant Staphylococcus aureus (MRSA) was the most common causative pathogen in nine patients. The most common extra-pulmonary septic foci were septic arthritis in five patients (29.4%), septic thrombophlebitis in four patients (23.5%), and infective endocarditis in two patients (11.8%). All patients exhibited wedge-shaped peripheral lesions and feeding vessel sign in CT chest, whereas bilateral diffuse lesions, nodular lesions, and cavitation were present in 94.1% of patients, pleural effusion was identified in 58.8% of patients, and pneumothorax was detected in 41.2% of patients. Fifteen patients improved and survived (88.2%), while two patients died (11.8%). CONCLUSION Early diagnosis of SPE with vigorous early therapy is critical for a better outcome, including appropriate antibiotics and timely surgical interference to eradicate extra-pulmonary septic foci.
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Affiliation(s)
- Rehab Elmeazawy
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Doaa El Amrousy
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Egypt.
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10
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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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11
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High risk and low prevalence diseases: Lemierre's syndrome. Am J Emerg Med 2022; 61:98-104. [DOI: 10.1016/j.ajem.2022.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/12/2022] [Accepted: 08/24/2022] [Indexed: 11/24/2022] Open
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12
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Kreuzpointner R, Valerio L, Corsi G, Zane F, Sacco C, Holm K, Righini C, Pecci A, Zweifel S, Barco S. Ophthalmic complications of Lemierre syndrome. Acta Ophthalmol 2022; 100:e314-e320. [PMID: 33829646 DOI: 10.1111/aos.14871] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Lemierre syndrome is a life-threatening condition characterized by head/neck bacterial infection, local suppurative thrombophlebitis and septic embolic complications in a range of sites of distant organs. No prior study focused on the course and characteristics of ophthalmic complications of Lemierre syndrome. METHODS We analysed data of 27 patients with ophthalmic complications from a large cohort of 712 cases with Lemierre syndrome reported globally between 2000 and 2017. We focused on initial manifestations, early (in-hospital) course and long-term ophthalmic deficits at the time of hospital discharge or during postdischarge follow-up. The study protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO (CRD42016052572). RESULTS Nine (33%) patients were women; the median age was 20 (Q1-Q3: 15-33) years. Fusobacterium spp. was involved in 56% of cases. The most prevalent initial manifestations were decreased vision (35%) and periocular oedema (38%), followed by impaired eye movements/nerve palsy (28%) and proptosis (28%). Venous involvement, notably cerebral vein thrombosis (70%) and ophthalmic vein thrombosis (55%), explained the symptomatology in most cases. Septic embolism (7%), orbital abscesses (2%) and carotid stenosis (14%) were also present. Ophthalmic sequelae were reported in 9 (33%) patients, often consisting of blindness or reduced visual acuity, and nerve paralysis/paresis. CONCLUSION Ophthalmic complications represent a severe manifestation of Lemierre syndrome, often reflecting an underlying cerebral vein thrombosis. Visual acuity loss and long-term severe complications are frequent. We call for an interdisciplinary approach to the management of patients with Lemierre syndrome and the routine involvement of ophthalmologists.
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Affiliation(s)
| | - Luca Valerio
- Center for Thrombosis and Hemostasis University Medical Center Mainz Mainz Germany
| | - Gabriele Corsi
- Department of Clinical, Integrated and Experimental Medicine (DIMES) Alma Mater Studiorum University of Bologna Bologna Italy
- Department of Pneumology and Respiratory Intensive Therapy Unit St Orsola University Hospital Bologna Italy
| | - Federica Zane
- Department of General Medicine Hospital of Sondrio Sondrio Italy
| | - Clara Sacco
- Thrombosis and Haemorrhagic Diseases Center Humanitas Clinical and Research Center‐IRCCS Milan Italy
| | - Karin Holm
- Department of Clinical Sciences Division of Infection Medicine Skåne University Hospital Lund University Lund Sweden
| | - Christian Righini
- Department of ENT, Head and Neck Surgery University Hospital of Grenoble Grenoble France
| | - Alessandro Pecci
- Department of Internal Medicine IRCCS Policlinico San Matteo Foundation and University of Pavia Pavia Italy
| | - Sandrine Zweifel
- Department of Ophthalmology University Hospital Zurich Zurich Switzerland
- University of Zurich Zurich Switzerland
| | - Stefano Barco
- Clinic of Angiology University Hospital Zurich Zurich Switzerland
- Center for Thrombosis and Hemostasis University Medical Center Mainz Mainz Germany
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13
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Pylephlebitis Caused by Fusobacterium nucleatum in a Septuagenarian Healthy Caucasian Male: Atypical Presentation of Lemierre’s Syndrome. Case Rep Infect Dis 2022; 2022:5160408. [PMID: 35127184 PMCID: PMC8808189 DOI: 10.1155/2022/5160408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 12/25/2021] [Accepted: 01/10/2022] [Indexed: 12/05/2022] Open
Abstract
Lemierre's syndrome (LS) is characterized by thrombophlebitis of the internal jugular vein caused primarily by Fusobacterium necrophorum. LS is usually suspected in fit young adults with prolonged or prior pharyngeal infection. Atypical Lemierre's syndrome is commonly defined as Fusobacterium-associated thrombophlebitis outside the head-neck veins and usually occurs in older patients than typical Lemierre's syndrome. Here we present a case of atypical LS in a septuagenarian healthy Caucasian male with no prior history of pharyngitis and in whom both computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated partial portal vein thrombosis associated with Fusobacterium nucleatum. This case report confirms previous reports of Fusobacterium nucleatum-associated LS variants presenting with abdominal vein thrombosis and illustrates clinical recovery after a combination of anticoagulation and antibiotic therapy.
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14
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Rheolytic mechanical thrombectomy in an oncological emergency. ANGIOLOGIA 2022. [DOI: 10.20960/angiologia.00381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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15
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Valerio L, Pleming W, Barco S. Re: Internal Jugular Vein and Cerebral Venous Sinus Infective Thrombophlebitis Detected With 99mTc-HMPAO White Blood Cell Scintigraphy. Clin Nucl Med 2021; 46:858-859. [PMID: 33630791 DOI: 10.1097/rlu.0000000000003536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Luca Valerio
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - William Pleming
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
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16
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Pravdic Z, Mitrovic M, Bogdanovic A, Virijevic M, Sabljic N, Pantic N, Vukovic NS. COVID-19 Presented with Deep Vein Thrombosis in a Patient with Paroxysmal Nocturnal Haemoglobinuria. Hamostaseologie 2021; 41:397-399. [PMID: 34544179 DOI: 10.1055/a-1554-6432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Paroxysmal nocturnal haemoglobinuria (PNH) is a rare, acquired clonal haematological disease characterized by complement-mediated haemolysis, bone marrow failure and venous thrombosis. Anticomplement therapy eculizumab improves survival and reduces complications. Severe acute respiratory distress syndrome corona virus 2 (SARS-CoV-2) disease 2019 (COVID-19) is associated with high incidence of both venous and arterial thrombosis in hospitalized patients with pneumonia. Deep venous thrombosis (DVT) as the presenting symptom of COVID-19 is a rare event. We describe a well-controlled PNH patient on eculizumab for more than 5 years who presented with DVT, while on warfarin, as the first sign of COVID-19. To our knowledge, this is the first described case of DVT in a PNH patient with COVID-19.
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Affiliation(s)
- Zlatko Pravdic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Mirjana Mitrovic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andrija Bogdanovic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marijana Virijevic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikica Sabljic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Nikola Pantic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Nada Suvajdzic Vukovic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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17
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Stessel B, Peeters J, Bruckers L, Nulens M, Callebaut I, Poelaert J, Dubois J. Bacterial surinfection and venous thromboembolism in critically ill ICU patients with COVID-19: What is the relationship? Thromb Res 2021; 206:139-141. [PMID: 34479130 PMCID: PMC8393514 DOI: 10.1016/j.thromres.2021.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/05/2021] [Accepted: 08/23/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Björn Stessel
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, LCRC, Agoralaan, 3590 Diepenbeek, Belgium.
| | - Jeroen Peeters
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Liesbeth Bruckers
- I-BioStat, Data Science Institute, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Marijke Nulens
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Ina Callebaut
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, LCRC, Agoralaan, 3590 Diepenbeek, Belgium
| | - Jan Poelaert
- Department of Intensive Care Medicine, Vrije Universiteit Brussel (VUB), University Hospital Brussels (UZ Brussel), Belgium; Faculty of Medicine and Pharmacy, VUB, Brussels, Belgium
| | - Jasperina Dubois
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
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18
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Getu S, Tiruneh T, Andualem H, Hailemichael W, Kiros T, Mesfin Belay D, Kiros M. Coagulopathy in SARS-CoV-2 Infected Patients: Implication for the Management of COVID-19. J Blood Med 2021; 12:635-643. [PMID: 34305416 PMCID: PMC8296964 DOI: 10.2147/jbm.s304783] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/16/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 disease has led to an extraordinary inclusive health crisis globally. Elevation of D-dimer is the major remarkable abnormal coagulation test in seriously ill COVID-19 patients. In nearly 50% of COVID-19 patients, the value of D-dimer was significantly enhancing. Recent literature indicated that COVID-19 patients were at higher risk of developing disseminated intravascular coagulation. Pro-inflammatory cytokines and chemokines are some of the factors leading to these conditions. The majority of COVID-19 patients showed a higher profile of pro-inflammatory cytokines and chemokines in severe clinical conditions. Tumor necrosis factor-α (TNF-α) and interleukins (ILs) elevated in COVID-19 infected patients. TNF-α, IL-6, and IL-1 are major cytokines vital for the inhibition of intrinsic anticoagulant pathways. COVID-19 becomes a higher complication with a significant effect on blood cell production and hemostasis cascades. Deep vein thrombosis and arterial thrombosis are common complications. Changes in hematological parameters are also frequently observed in COVID-19 patients. Especially, thrombocytopenia is an indicator for poor prognosis of the disease and is highly expected and aggravates the likelihood of death of SARS-CoV-2 infected individuals. Thrombopoiesis reduction in COVID-19 patients might be due to viral abuse of the bone marrow/the viral load may affect thrombopoietin production and function. In other ways, immune-inflammation-mediated destruction and increased consumption of platelets are also the possible proposed mechanisms for thrombocytopenia. Therefore, the counting of platelet cells is an easily accessible biomarker for disease monitoring. All SARS-CoV-2 infected patients should be admitted and identifying potential higher-risk patients. It is also obligatory to provide appropriate treatments with intensive care and strict follow-up. In addition, considerations of chronic diseases are essential for better prognosis and recovery. The current review discusses coagulopathy among SARS-CoV-2 infected individuals and its complication for the management of the disease.
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Affiliation(s)
- Sisay Getu
- Hematology and Immuno-hematology, Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tegenaw Tiruneh
- Hematology and Immuno-hematology, Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Henok Andualem
- Immunology and Molecular Biology, Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wasihun Hailemichael
- Immunology and Molecular Biology, Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Teklehayimanot Kiros
- Microbiology, Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demeke Mesfin Belay
- Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulugeta Kiros
- Microbiology, Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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19
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Tahir N, Sherchan R, Farooqi A, Shrestha J, Jeelani HM. Idiopathic Ovarian Vein Thrombosis: A Rare Cause of Abdominal Pain. Cureus 2021; 13:e16756. [PMID: 34513379 PMCID: PMC8412189 DOI: 10.7759/cureus.16756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/12/2022] Open
Abstract
Ovarian vein thrombosis (OVT) is a rare entity. It is usually seen in hypercoagulable states such as pregnancy, peripartum period, active malignancy, recent pelvic surgeries, pelvic infections, and inherited or acquired thrombophilias. Idiopathic OVT is exceedingly rare. We report a case of OVT in a healthy 42-year-old post-menopausal female presenting with right lower quadrant abdominal pain for four days. The patient denied any recent pelvic surgery, pelvic infection, or any family history of thrombophilia. Right ovarian vein thrombosis was found on a computed tomography scan of the abdomen and pelvis. Laboratory workup including hypercoagulability studies was normal. The patient was treated with a therapeutic dose of lower molecular weight heparin and later transitioned to rivaroxaban for three to six months. This case emphasizes OVT as a differential diagnosis of lower abdominal pain in healthy females. Currently, there are no standard guidelines for the duration of anticoagulation in OVT, however based on literature review, deep venous thrombosis treatment guidelines can be followed.
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Affiliation(s)
- Nayha Tahir
- Internal Medicine, Northwestern Medicine McHenry Hospital, Rosalind Franklin University of Medicine and Science, McHenry, USA
| | - Robin Sherchan
- Internal Medicine, Northwestern Medicine McHenry Hospital, Rosalind Franklin University of Medicine and Science, McHenry, USA
| | - Aneeba Farooqi
- Internal Medicine, Northwestern Medicine McHenry Hospital, Rosalind Franklin University of Medicine and Science, McHenry, USA
| | - Jishna Shrestha
- Internal Medicine, Northwestern Medicine McHenry Hospital, Rosalind Franklin University of Medicine and Science, McHenry, USA
| | - Hafiz Muhammad Jeelani
- Internal Medicine, Northwestern Medicine McHenry Hospital, Rosalind Franklin University of Medicine and Science, McHenry, USA
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20
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Abstract
Although ovarian vein thrombosis (OVT) is classically considered a puerperal pathology, it can also occur in nonpuerperal settings such as endometritis, pelvic inflammatory disease, Crohn's disease, pelvic or gynaecological surgeries and thrombophilia. Hypercoagulation conditions such as antiphospholipid syndrome, systemic lupus erythematosus, factor V Leiden and protein C and S deficiency are all recognised risk factors. It is also a known complication during pregnancy often presenting with fever and lower abdominal pain within weeks after delivery. Its incidence is exceedingly rare, occurring in 0.05% of all pregnancies that result in live births and peaking around 2-6 days after delivery. Its preferential involvement of the right ovarian vein may be explained by the compression of the inferior vena cava and the right ovarian vein due to dextrorotation of the uterus during pregnancy. Furthermore, antegrade flow of blood and multiple incompetent valves in the right ovarian vein favours bacterial infection. Complications may include sepsis and thrombus extension to the inferior vena cava or left renal vein and rarely, pulmonary embolism. The authors present the case of a 27-year-old woman with lower abdominal pain 5 weeks after an elective caesarean section. Although the diagnosis of postpartum endometritis was initially considered, a CT suggested a right OVT. She commenced treatment with low-molecular weight heparin. A high index of clinical suspicion is required in order to establish the diagnosis of this rare cause of abdominal pain, which can mimic an acute abdomen.
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Affiliation(s)
- Louise Dunphy
- Surgery, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Aie Wei Tang
- Obstetrics, Liverpool Women's Hospital, Liverpool, UK
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21
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Abstract
Lemierre syndrome is a rare form of septic thrombophlebitis of the head and neck veins, most typically the internal jugular vein, which affects otherwise healthy adolescents and young adults after an oropharyngitis or other local infection and is characterized by multiple septic embolization. Despite treatment, Lemierre syndrome displays a high rate of in-hospital complications that include thrombus progression and new peripheral septic embolization, and it can be fatal or cause disabling sequelae. The mainstay of treatment is antibiotic therapy; anticoagulation is often used, but its role is controversial. Surgical treatment is often necessary in case of peripheral septic lesions. In the absence of prospective studies, what little guidance exists on its management is based on case series or on analogy with similar conditions such as other forms of septic thrombophlebitis or non-septic venous thrombosis. Over the last few years, new observational evidence has improved our knowledge of the clinical epidemiology of this condition and highlighted a number of promising management strategies. We provide an overview of the treatment patterns observed in the contemporary era, summarise the arguments proposed so far against or in favour of alternative treatments as well as possible decision rules on the use of anticoagulation, and outline the priorities of ongoing and future observational and interventional research.
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Affiliation(s)
- Luca Valerio
- Center for Thrombosis and Hemostasis, University Medical Center, University of Mainz, Mainz, Germany -
| | - William Pleming
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Stefano Barco
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
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22
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Venous Thromboembolic Disease in Chronic Inflammatory Lung Diseases: Knowns and Unknowns. J Clin Med 2021; 10:jcm10102061. [PMID: 34064992 PMCID: PMC8151562 DOI: 10.3390/jcm10102061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 12/13/2022] Open
Abstract
Persistent inflammation within the respiratory tract underlies the pathogenesis of numerous chronic pulmonary diseases. There is evidence supporting that chronic lung diseases are associated with a higher risk of venous thromboembolism (VTE). However, the relationship between lung diseases and/or lung function with VTE is unclear. Understanding the role of chronic lung inflammation as a predisposing factor for VTE may help determine the optimal management and aid in the development of future preventative strategies. We aimed to provide an overview of the relationship between the most common chronic inflammatory lung diseases and VTE. Asthma, chronic obstructive pulmonary disease, interstitial lung diseases, or tuberculosis increase the VTE risk, especially pulmonary embolism (PE), compared to the general population. However, high suspicion is needed to diagnose a thrombotic event early as the clinical presentation inevitably overlaps with respiratory disorders. PE risk increases with disease severity and exacerbations. Hence, hospitalized patients should be considered for thromboprophylaxis administration. Conversely, all VTE patients should be asked for lung comorbidities before determining anticoagulant therapy duration, as those patients are at increased risk of recurrent PE episodes rather than DVT. Further research is needed to understand the underlying pathophysiology of in-situ thrombosis in those patients.
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23
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Sakamoto A, Ogura M, Hattori A, Tada K, Horikawa R, Nakadate H, Matsumoto K, Nogami K, Ieko M, Ishiguro A. Lupus anticoagulant hypoprothrombinemia syndrome associated with bilateral adrenal haemorrhage in a child: early diagnosis and intervention. Thromb J 2021; 19:19. [PMID: 33731125 PMCID: PMC7968225 DOI: 10.1186/s12959-021-00271-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/09/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Lupus anticoagulant-hypoprothrombinemia syndrome (LAHPS) is characterized by bleeding and thrombosis in patients with autoimmune diseases or infections. Paediatric LAHPS exhibits various degrees of bleeding, ranging from mild to severe; however, adrenal haemorrhage due to LAHPS and its long-term clinical course have not been sufficiently described. CASE PRESENTATION A 9-year-old boy presented with prolonged abdominal pain and abnormal coagulation screening tests. The laboratory tests showed prolonged activated partial thromboplastin time and subsequently revealed the presence of lupus anticoagulant, anti-nuclear antibodies, and hypoprothrombinemia, leading to diagnosis of LAHPS. An enhanced computed tomogram demonstrated nodular lesions in the adrenal glands bilaterally, suggestive of adrenal haemorrhage. Laboratory and clinical manifestations exhibited life-threatening adrenal insufficiency that required hydrocortisone administration. The patient developed systemic lupus erythematosus, diagnosed 12 months later. CONCLUSIONS This patient with LAHPS developed rare adrenal failure due to adrenal haemorrhage, a life-threatening event that should be recognized and treated early. In our case, renal dysfunction was also observed when systemic lupus erythematosus was diagnosed 1 year after LAHPS. Our case emphasizes that early recognition of adrenal failure and careful long-term observation is required in patients with autoantibodies.
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Affiliation(s)
- Atsushi Sakamoto
- Center for Postgraduate Education and Training, National Center for Child Health and Development, NCCHD, Tokyo, Japan. .,Children's Cancer Center, National Center for Child Health and Development, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Masao Ogura
- Division of Nephrology and Rheumatology, NCCHD, Tokyo, Japan
| | - Atsushi Hattori
- Division of Endocrinology and Metabolism, NCCHD, Tokyo, Japan
| | - Kinji Tada
- Center for Postgraduate Education and Training, National Center for Child Health and Development, NCCHD, Tokyo, Japan
| | - Reiko Horikawa
- Division of Endocrinology and Metabolism, NCCHD, Tokyo, Japan
| | | | - Kimikazu Matsumoto
- Children's Cancer Center, National Center for Child Health and Development, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Keiji Nogami
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
| | - Masahiro Ieko
- Department of Internal Medicine, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, NCCHD, Tokyo, Japan.,Division of Hematology, NCCHD, Tokyo, Japan
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24
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Valerio L, Corsi G, Granziera S, Holm K, Hotz MA, Jankowski M, Konstantinides SV, Kucher N, Nicoletti T, Reinhardt C, Righini C, Sacco C, Trinchero A, Zane F, Pecci A, Barco S. Sex differences in Lemierre syndrome: Individual patient-level analysis. Thromb Res 2021; 202:36-39. [PMID: 33713865 DOI: 10.1016/j.thromres.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/13/2021] [Accepted: 03/01/2021] [Indexed: 01/10/2023]
Affiliation(s)
- Luca Valerio
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.
| | - Gabriele Corsi
- Department of Clinical, Integrated and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Serena Granziera
- Department of Geriatrics, San Giovanni e Paolo Hospital, Venice, Italy
| | - Karin Holm
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden.
| | - Michel-André Hotz
- Department of ENT, Head and Neck Surgery, Inselspital, University of Bern, CH-3010 Bern, Switzerland.
| | - Marius Jankowski
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Nils Kucher
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland.
| | - Tommaso Nicoletti
- Institute of Neurology, Catholic University of the Sacred Heart, Rome, Italy; Institute of Neurology, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Christoph Reinhardt
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.
| | - Christian Righini
- Department of ENT, Head and Neck Surgery, University Hospital of Grenoble, Grenoble, France.
| | - Clara Sacco
- Center for Thrombosis and Hemorrhagic Diseases, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Alice Trinchero
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland.
| | - Federica Zane
- Department of General Medicine, Hospital of Sondrio, Sondrio, Italy
| | - Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy.
| | - Stefano Barco
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany; Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland.
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25
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Abstract
Ovarian vein thrombosis (OVT) is a rare type of venous thromboembolism. The most common risk factors for OVT include pregnancy, oral contraceptives, malignancies, recent surgery, and pelvic infections; however, in 4 to 16% of cases, it can be classified as idiopathic. Most of the available information regards pregnancy-related OVT, which has been reported to complicate 0.01 to 0.18% of pregnancies and to peak around 2 to 6 days after delivery or miscarriage/abortion. The right ovarian vein is more frequently involved (70-80% of cases). Clinical features of OVT include abdominal pain and tenderness, fever, and gastrointestinal symptoms. The most typical finding is the presence of a palpable abdominal mass, although reported in only 46% of cases. OVT can be the cause of puerperal fever in approximately a third of women. Ultrasound Doppler is the first-line imaging, because of its safety, low cost, and wide availability. However, the ovarian veins are difficult to visualize in the presence of bowel meteorism or obesity. Thus, computed tomography or magnetic resonance imaging is often required to confirm the presence and extension of the thrombosis. In oncological patients, OVT is often an incidental finding at abdominal imaging. Mortality related to OVT is nowadays low due to the combination treatment of parenteral broad-spectrum antibiotics (until at least 48 hours after fever resolution) and anticoagulation (low-molecular-weight heparin, vitamin K antagonists, or direct oral anticoagulants). Anticoagulant treatment duration of 3 to 6 months has been recommended for postpartum OVT, while no anticoagulation has been suggested for incidentally detected cancer-associated OVT.
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Affiliation(s)
- Nicoletta Riva
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.,Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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26
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Valerio L, Corsi G, Sebastian T, Barco S. Lemierre syndrome: Current evidence and rationale of the Bacteria-Associated Thrombosis, Thrombophlebitis and LEmierre syndrome (BATTLE) registry. Thromb Res 2020; 196:494-499. [DOI: 10.1016/j.thromres.2020.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 01/24/2023]
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27
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Nygren D, Elf J, Torisson G, Holm K. Jugular Vein Thrombosis and Anticoagulation Therapy in Lemierre's Syndrome -A Post Hoc Observational and Population-Based Study of 82 Patients. Open Forum Infect Dis 2020; 8:ofaa585. [PMID: 33447643 PMCID: PMC7793455 DOI: 10.1093/ofid/ofaa585] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/25/2020] [Indexed: 12/20/2022] Open
Abstract
Background Lemierre’s syndrome is typically caused by Fusobacterium necrophorum where an oropharyngeal infection is followed by septic internal jugular vein thrombophlebitis with subsequent septic embolization. Yet, the pathogenesis of septic thrombophlebitis, differences dependent on the presence of jugular vein thrombosis, and the role of anticoagulant therapy are insufficiently understood. Methods Patients with invasive infection with F. necrophorum and Lemierre’s syndrome who had been investigated for jugular vein thrombosis were included from a previous population-based observational study in Sweden. Medical records were reviewed and compared in patients with and without jugular vein thrombosis. Then, patients with jugular vein thrombosis were compared by exposure to therapeutic, prophylactic, or no anticoagulation. Outcomes examined were thrombosis progression, early or late peripheral septic complications, chronic major sequelae, 30-day mortality, and major bleeding. Results Fifty-one of 82 (62%) radiologically investigated patients with Lemierre’s syndrome had jugular vein thrombosis. Patients with jugular vein thrombosis had lower platelet levels (median, 76 vs 112 ×109/L; P = .04) on presentation and more days to defervesence (12 vs 7 days; P = .03) yet similar rates of major sequelae and 30-day mortality. No significant differences in outcomes were seen between patients with jugular vein thrombosis exposed to therapeutic, prophylactic, or no anticoagulation therapy, yet study outcomes were rare. Conclusions Patients with Lemierre’s syndrome with jugular vein thrombosis were more severely affected, yet had similar prognosis. Most patients with jugular vein thrombosis recovered well without therapeutic anticoagulation therapy, though adverse events were similarly rare in anticoagulated patients. The observational design and rarity of study outcomes require cautious interpretation.
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Affiliation(s)
- David Nygren
- Division of Infection Medicine, Department for Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Johan Elf
- Center of Thrombosis and Haemostasis, Skåne University Hospital, Malmö, Sweden
| | - Gustav Torisson
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Karin Holm
- Division of Infection Medicine, Department for Clinical Sciences Lund, Lund University, Lund, Sweden
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