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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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2
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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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3
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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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4
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Zamora Gonzalez RA, Sarria JC, Christians NA, Baliss M. Lemierre’s Syndrome Due to Methicillin-Resistant Staphylococcus aureus. J Investig Med High Impact Case Rep 2019; 7:2324709619890967. [PMID: 31795752 PMCID: PMC6893931 DOI: 10.1177/2324709619890967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Lemierre’s syndrome is an uncommon and potentially fatal complication of oropharyngeal and facial infections. It involves an associated septic thrombophlebitis, bacteremia, and septic emboli. Traditionally, compromise of the internal jugular vein has been described in conjunction with an infection caused by anaerobes, especially, Fusobacterium necrophorum. In recent years, however, variant forms have been appearing, including other vessel compromise and other etiologic agents. We present the case of Lemierre’s syndrome in a 31-year-old male with facial vein thrombosis, septic emboli to the lungs, and bacteremia caused by methicillin-resistant Staphylococcus aureus. We hope that this case will raise awareness about variant presentations and promote a timely diagnosis and appropriate treatment of this potentially fatal infection.
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5
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Alabraba E, Manu N, Fairclough G, Sutton R. Acute parotitis due to MRSA causing Lemierre's syndrome. Oxf Med Case Reports 2018; 2018:omx056. [PMID: 29942528 PMCID: PMC6007696 DOI: 10.1093/omcr/omx056] [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: 01/12/2017] [Revised: 07/13/2017] [Indexed: 11/16/2022] Open
Abstract
We report a case of septic thrombophlebitis of the right internal jugular vein linked with right-sided acute parotitis caused by methicillin-resistant Staphylococcus aureus (MRSA) in a patient who had recently undergone a pylorus-preserving pancreaticoduodenectomy. Our case is unique because acute parotitis is a less-recognized cause of Lemierre’s syndrome, never previously linked with MRSA infection in this context. We review the literature on diagnosis and management of Lemierre’s syndrome caused by acute parotitis. Prompt diagnosis and aggressive antibiotics ensured a favourable outcome.
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Affiliation(s)
- Edward Alabraba
- Liverpool NIHR Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool L69 3GA, UK
| | - Nichola Manu
- Liverpool NIHR Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool L69 3GA, UK
| | - Gemma Fairclough
- Liverpool NIHR Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool L69 3GA, UK
| | - Robert Sutton
- Liverpool NIHR Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool L69 3GA, UK
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6
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Mattke AC, Prabhu S, Clark J, Labrom R, Burns H, Schlapbach LJ. Lemierre's syndrome, necrotizing pneumonia and staphylococcal septic shock treated with extracorporeal life support. SAGE Open Med Case Rep 2017; 5:2050313X17722726. [PMID: 28835825 PMCID: PMC5542080 DOI: 10.1177/2050313x17722726] [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: 03/30/2017] [Accepted: 06/27/2017] [Indexed: 11/25/2022] Open
Abstract
Objectives: Lemierre’s syndrome cause by methicillin-sensitive Staphylococcus aureus is rare, but can lead to necrotizing pneumonia and septicaemia. When treating such patient with extracorporeal life support source control can be both challenging and controversial. Methods: In this report we present a 12 year old male who presented with Lemierre’s syndrome from which he developed septic shock and severe necrotizing pneumonia. He also showed multiple pulmonary embolisms from the internal jugular vein thrombi, resulting in acute respiratory distress syndrome. Results: The patient was treated with extracorporeal life support. Subsequent computed tomography revealed multiple abscesses throughout his lungs and around vertebral bodies C1 and C2, for which source control with drainage of the cervical abscesses was achieved while on extracorporeal life support. The necrotizing pneumonia gradually improved, and partial pneumectomy was avoided. He was successfully separated from extracorporeal life support and respiratory support and recovered from his illness. Follow-up imaging showed almost complete resolution of the pulmonary abscesses. Osteomyelitis of C1/C2 and severe muscle wasting required a prolonged hospital stay. Conclusion: This case highlights the challenges of supporting patients suffering from disseminated staphylococcal sepsis with extracorporeal life support and the key role of source control and demonstrates the value of using extracorporeal life support in necrotizing pneumonia.
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Affiliation(s)
- Adrian C Mattke
- Queensland Paediatric Cardiac Services, Lady Cilento Children's Hospital (LCCH), South Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Paediatric Critical Care Research Group, Mater Medical Research Institute, QLD, Australia.,Paediatric Intensive Care Unit, Lady Cilento Children's Hospital (LCCH), South Brisbane, QLD, Australia.,Department of Critical Care Medicine, Lady Cilento Children's Hospital (LCCH), South Brisbane, QLD, Australia
| | - Sudesh Prabhu
- Queensland Paediatric Cardiac Services, Lady Cilento Children's Hospital (LCCH), South Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Paediatric Critical Care Research Group, Mater Medical Research Institute, QLD, Australia
| | - Julia Clark
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Paediatric Infection Management Service, Lady Cilento Children's Hospital (LCCH), South Brisbane, QLD, Australia
| | - Robert Labrom
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Orthopaedic Surgery, Lady Cilento Children's Hospital (LCCH), South Brisbane, QLD, Australia
| | - Hanna Burns
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Otolaryngology, Head and Neck Surgery, Lady Cilento Children's Hospital (LCCH), South Brisbane, QLD, Australia
| | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, Mater Medical Research Institute, QLD, Australia.,Paediatric Intensive Care Unit, Lady Cilento Children's Hospital (LCCH), South Brisbane, QLD, Australia.,Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland
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Abstract
Staphylococcus aureus, although generally identified as a commensal, is also a common cause of human bacterial infections, including of the skin and other soft tissues, bones, bloodstream, and respiratory tract. The history of S. aureus treatment is marked by the development of resistance to each new class of antistaphylococcal antimicrobial drugs, including the penicillins, sulfonamides, tetracyclines, glycopeptides, and others, complicating therapy. S. aureus isolates identified in the 1960s were sometimes resistant to methicillin, a ß-lactam antimicrobial active initially against a majority S. aureus strains. These MRSA isolates, resistant to nearly all ß-lactam antimicrobials, were first largely confined to the health care environment and the patients who attended it. However, in the mid-1990s, new strains, known as community-associated (CA-) MRSA strains, emerged. CA-MRSA organisms, compared with health care-associated (HA-) MRSA strain types, are more often susceptible to multiple classes of non ß-lactam antimicrobials. While infections caused by methicillin-susceptible S. aureus (MSSA) strains are usually treated with drugs in the ß-lactam class, such as cephalosporins, oxacillin or nafcillin, MRSA infections are treated with drugs in other antimicrobial classes. The glycopeptide drug vancomycin, and in some countries teicoplanin, is the most common drug used to treat severe MRSA infections. There are now other classes of antimicrobials available to treat staphylococcal infections, including several that have been approved after 2009. The antimicrobial management of invasive and noninvasive S. aureus infections in the ambulatory and in-patient settings is the topic of this review. Also discussed are common adverse effects of antistaphylococcal antimicrobial agents, advantages of one agent over another for specific clinical syndromes, and the use of adjunctive therapies such as surgery and intravenous immunoglobulin. We have detailed considerations in the therapy of noninvasive and invasive S. aureus infections. This is followed by sections on specific clinical infectious syndromes including skin and soft tissue infections, bacteremia, endocarditis and intravascular infections, pneumonia, osteomyelitis and vertebral discitis, epidural abscess, septic arthritis, pyomyositis, mastitis, necrotizing fasciitis, orbital infections, endophthalmitis, parotitis, staphylococcal toxinoses, urogenital infections, and central nervous system infections.
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Franco-Paredes C. Upper Airway Infections. CORE CONCEPTS IN CLINICAL INFECTIOUS DISEASES (CCCID) 2016. [PMCID: PMC7173413 DOI: 10.1016/b978-0-12-804423-0.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Infections of the upper respiratory tract represent an important source of morbidity and potentially of life-threatening complications. This group of infections represents one of the most frequent outpatient consultations; and includes a range of clinical syndromes that may go from a self-limited common cold, to acute rhinosinusitis, otitis media, to life threatening condition such as epiglottitis. Importantly, acute respiratory illness account for approximately 75% of the total number of antibiotic prescriptions per year; an often many of these conditions are of viral origin. When acute pharyngitis is caused by Streptococcus pyogenes, it is important to consider treatment to prevent transmission, reduce symptoms, and prevent its associated suppurative and nonsuppurative complications. Acute bacterial sinusitis can be associated with severe complications. Upper respiratory infection can also lead to life-threatening infections of the peripharyngeal and deep fascial spaces of the head and neck.
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Choi BM, Son SW, Park CK, Lee SH, Yoon HK. Extensive Bilateral Lemierre Syndrome due to Methicillin-Resistant Staphylococcus epidermidis in a Patient with Lung Adenocarcinoma. Tuberc Respir Dis (Seoul) 2015; 78:289-92. [PMID: 26175788 PMCID: PMC4499602 DOI: 10.4046/trd.2015.78.3.289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/26/2015] [Accepted: 05/12/2015] [Indexed: 11/24/2022] Open
Abstract
Lemierre syndrome (LS) is a septic thrombophlebitis of the internal jugular vein (IJV) following an oropharyngeal infection. LS is commonly caused by normal anaerobic flora and treated with appropriate antibiotics and anticoagulation therapy. Although the incidence of disease is very rare, 15% cases of LS are fatal even in the antibiotic era because of disseminated septic thromboemboli. We reported a case of extensive bilateral LS due to methicillin-resistant Staphylococcus epidermidis in a 63-year-old female with lung adenocarcinoma. Initial examination revealed a retropharyngeal abscess; hence, intravenous ceftriaxone and steroid were initiated empirically. However, pulmonary thromboembolism developed and methicillin-resistant S. epidermidis was identified in the bacterial culture. Despite intensive antibiotic and anticoagulation therapies, extensive septic thrombophlebitis involving the bilateral IJV and superior vena cava developed. Adjunctive catheter-directed thrombolysis and superior vena cava stenting were performed and the patient received antibiotic therapy for an additional 4 weeks, resulting in complete recovery.
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Affiliation(s)
- Bo Mi Choi
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Seong Wan Son
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chan Kwon Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Hoon Lee
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Kyu Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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10
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Gunatilake SSC, Yapa LG, Gallala M, Gamlath R, Rodrigo C, Wimalaratna H. Lemierre's syndrome secondary to community-acquired methicillin-resistant Staphylococcus aureus infection presenting with cardiac tamponade, a rare disease with a life-threatening presentation: a case report. Int J Emerg Med 2015; 7:39. [PMID: 25635199 PMCID: PMC4306077 DOI: 10.1186/s12245-014-0039-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 09/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lemierre's syndrome is a rare condition characterized by thrombophlebitis of internal jugular vein, septicemia and septic metastatic infection of different organs. It is preceded by an oropharyngeal infection by anaerobic organisms. Community-acquired methicillin-resistant Staphylococcus aureus is now emerging as a causative organism in Lemierre's syndrome. Clinical manifestations vary depending on the organ system affected by the infection. Although rare, patients may present with life-threatening conditions such as cardiac tamponade. CASE PRESENTATION We report the first case, to our knowledge, of Lemierre's syndrome presenting with cardiac tamponade secondary to community-acquired methicillin-resistant S. aureus in a previously well 45-year-old Sri Lankan lady. Fever, sore throat and left-sided neck pain complicated with facial and left upper limb swelling were followed by severe shortness of breath for 24 h. There was tachycardia with pulsus paradoxus, low blood pressure and soft heart sounds. Pericardial effusion with cardiac tamponade was detected on echocardiogram and methicillin-resistant S. aureus species were isolated in both blood and pericardial fluid cultures. Venous duplex of neck veins and computed tomography scan of the neck showed thrombosis of left-sided internal jugular, external jugular, subclavian and axillary veins. Diagnosis of Lemierre's syndrome was made, and patient had a satisfactory recovery following emergency pericardiocentesis and a prolonged course of antibiotics. CONCLUSIONS Although uncommon, Lemierre's syndrome is a life-threatening condition. Patients may present with cardiac tamponade secondary to purulent pericarditis in Lemierre's syndrome, where emergency pericardiocentesis is lifesaving. Community-acquired methicillin-resistant S. aureus is emerging as a causative agent in Lemierre's syndrome, and awareness is required amongst physicians for prompt diagnosis and appropriate empirical treatment to prevent mortality and morbidity associated with the disease.
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Affiliation(s)
| | | | - Malinga Gallala
- Department of Medicine, Teaching Hospital, Kandy 20000, Sri Lanka
| | - Rohitha Gamlath
- Department of Medicine, Teaching Hospital, Kandy 20000, Sri Lanka
| | - Chaturaka Rodrigo
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 00300, Sri Lanka
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Cardenas-Garcia J, Narasimhan M, Koenig SJ. A teenager with fever and sore throat. Diagnosis: Lemierre syndrome. Chest 2014; 145:e10-e13. [PMID: 24687725 DOI: 10.1378/chest.13-2260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jose Cardenas-Garcia
- Department of Pulmonary, Critical Care, and Sleep Medicine, Hofstra North Shore-LIJ School of Medicine, Oakland Gardens, NY.
| | - Mangala Narasimhan
- Department of Pulmonary, Critical Care, and Sleep Medicine, Hofstra North Shore-LIJ School of Medicine, Oakland Gardens, NY
| | - Seth J Koenig
- Department of Pulmonary, Critical Care, and Sleep Medicine, Hofstra North Shore-LIJ School of Medicine, Oakland Gardens, NY
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12
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Unusual Presentation of Lemierre Syndrome. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0b013e31828d701f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Lemierre syndrome from a neck abscess due to methicillin-resistant Staphylococcus aureus. Braz J Infect Dis 2013; 17:507-9. [PMID: 23797007 PMCID: PMC9428241 DOI: 10.1016/j.bjid.2012.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 11/15/2012] [Accepted: 11/16/2012] [Indexed: 12/02/2022] Open
Abstract
Lemierre syndrome is characterized by acute septic thrombophlebitis of the internal jugular vein (IJV) that develops after an oropharyngeal infection, and can be complicated by septic emboli to lungs and other organs. The most frequent causative agent is Fusobacterium necrophorum, an anaerobic bacillus found in normal oropharyngeal flora. Staphylococcus aureus has emerged as a cause of Lemierre syndrome in the last decade. We report a case of a 24-year-old man who developed septic IJV thrombosis and necrotizing pneumonia due to S. aureus from an infected hematoma in the right sternocleidomastoid muscle. Antibiotics are the mainstay of therapy with few cases needing anticoagulation. A good outcome is dependent upon an awareness of the condition, a high index of suspicion, and prompt initiation of antibiotic therapy. Recognition of S. aureus as a cause of Lemierre syndrome can guide the choice of initial antibiotics to cover this virulent pathogen.
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14
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Methicillin-resistant Staphylococcus aureus bacteraemia associated with Lemierre's syndrome: case report and literature review. The Journal of Laryngology & Otology 2013; 127:721-3. [DOI: 10.1017/s0022215113001035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Community-acquired methicillin-resistant Staphylococcus aureus is a growing health concern. Lemierre's syndrome is a septic jugular thrombophlebitis that primarily affects young adults. This paper aimed to identify a possible sub-group of Lemierre's syndrome cases associated with community-acquired methicillin-resistant Staphylococcus aureus.Method:This paper reports the case of a 16-year-old male who was admitted for increasing fever, tachycardia, tachypnoea and neck pain. The patient was diagnosed with methicillin-resistant Staphylococcus aureus bacteraemia associated with Lemierre's syndrome. A literature review was subsequently conducted.Results:Following intravenous antibiotic treatment and the sterilisation of blood cultures, the patient improved. The literature review indicated a rise in the past 2 years of Lemierre's syndrome associated with methicillin-resistant Staphylococcus aureus among patients less than 18 years of age.Conclusion:Community-acquired methicillin-resistant Staphylococcus aureus bacteraemia can lead to pulmonary sequelae. When it is associated with pharyngitis, nasopharyngitis or parapharyngeal lymphadenitis, the affected patient may be predisposed to Lemierre's syndrome. As bacterial carriage is predominantly nasal, pharyngitis may not be present. Methicillin-resistant Staphylococcus aureus should be included as an offending bacterium where there is suspicion of Lemierre's syndrome. It is unclear whether anticoagulation alters the course of the bacterium, and surgery is probably contraindicated.
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15
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Mação P, Cancelinha C, Lopes P, Rodrigues F. An 11-year-old boy with pharyngitis and cough: Lemierre syndrome. BMJ Case Rep 2013; 2013:bcr-2012-008527. [PMID: 23616317 DOI: 10.1136/bcr-2012-008527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The authors present the case of an 11-year-old boy with pharyngitis, treated with amoxicillin, that worsened on day 7, with cough, high fever and refusal to eat. Lethargy and respiratory distress were noted. Based on radiographic findings of bilateral infiltrates he was diagnosed with pneumonia and started on intravenous ampicillin and erythromycin. Two days later he complained of right-sided neck pain and a palpable mass was identified. An ultrasound showed partial thrombosis of the right internal jugular vein and a lung CT scan revealed multiple septic embolic lesions. Lemierre syndrome was diagnosed, antibiotic treatment adjusted and anticoagulation started. A neck CT-scan showed a large parapharyngeal abscess. His clinical condition improved gradually and after 3 weeks of intravenous antibiotics he was discharged home on oral treatment. This case illustrates the importance of diagnosing Lemierre syndrome in the presence of pharyngitis with localised neck pain and respiratory distress, to prevent potentially fatal complications.
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Affiliation(s)
- Patricia Mação
- Department of Emergency Service and Infectious Disease Unit, Hospital Pediátrico Coimbra, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal.
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16
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Derber CJ, Troy SB. Head and neck emergencies: bacterial meningitis, encephalitis, brain abscess, upper airway obstruction, and jugular septic thrombophlebitis. Med Clin North Am 2012; 96:1107-26. [PMID: 23102480 DOI: 10.1016/j.mcna.2012.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Head and neck infectious disease emergencies can be rapidly fatal without prompt recognition and treatment. Empiric intravenous (IV) antibiotics should be initiated immediately in any patient with suspected bacterial meningitis, and IV acyclovir in any patient with suspected encephalitis. Surgical intervention is often necessary for brain abscesses, epiglottitis, and Ludwig's angina. A high index of suspicion is often needed to diagnose epiglottitis, Ludwig's angina, and Lemierre's syndrome. Brain infections can have high morbidity among survivors. In this article, the causes, diagnostic tests, treatment, and prognosis are reviewed for some of the more common head and neck infectious disease emergencies.
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Affiliation(s)
- Catherine J Derber
- Department of Internal Medicine, Division of Infectious Diseases, Eastern Virginia Medical School, Norfolk, VA, USA.
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17
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Stauffer C, Josiah AF, Fortes M, Menaker J, Cole JW. Lemierre syndrome secondary to community-acquired methicillin-resistant Staphylococcus aureus infection associated with cavernous sinus thromboses. J Emerg Med 2012; 44:e177-82. [PMID: 22989693 DOI: 10.1016/j.jemermed.2012.02.075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/04/2011] [Accepted: 02/13/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Lemierre Syndrome (LS) is a highly aggressive rare disease process with a predilection for young, healthy adolescents. Often beginning with a primary cervicofacial infection, LS rapidly progresses to thrombophlebitis of the cerebral vasculature, metastatic infection, and septicemia. Untreated LS can be rapidly fatal. Thrombus within the cerebral vasculature can have devastating neurological effects. Advances in antibacterial therapy have resulted in a global decline in the incidence of LS, and clinicians may not consider LS early in the disease process. Although the mortality of LS has declined, the morbidity associated with the disease has increased, particularly the neurological sequelae. OBJECTIVES This report will provide readers with a better understanding of the etiology, clinical presentation, evaluation methods, and appropriate treatment of LS. CASE REPORT We present an atypical case of LS secondary to community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infection progressing to bilateral cavernous sinus and ophthalmic vein thromboses with resultant binocular vision loss secondary to optic nerve and retinal ischemia. CONCLUSION This case highlights the importance of early recognition of LS in the setting of a community-acquired MRSA infection as the unifying condition in a young patient with multiple acute neurologic impairments.
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Affiliation(s)
- Craig Stauffer
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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18
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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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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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