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Miyazaki M, Hattori H. Lemierre's Syndrome Caused by Streptococcus milleri Group. Intern Med 2024; 63:1289-1294. [PMID: 37743513 PMCID: PMC11116006 DOI: 10.2169/internalmedicine.2311-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/06/2023] [Indexed: 09/26/2023] Open
Abstract
A 64-year-old woman was transported to the emergency room with a headache and fever. She presented with a right ocular protrusion, hyperemia, and tenderness in the neck. Contrast-enhanced MRI of the head showed a high DWI signal in the bilateral sphenoid sinuses and contrast defects along the bilateral internal jugular and superior ophthalmic veins. Blood and CSF cultures revealed Streptococcus milleri group. Surgery was performed for Lemierre's syndrome secondary to sphenoid sinusitis. The patient was treated with antibiotics and anticoagulant therapy, but a duodenal ulcer and brain abscess thereafter developed. However, multidisciplinary endoscopic and surgical treatment saved her life.
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Jena N, Yella PR, Chandramohan D. Lemierre's Syndrome Due to Streptococcus anginosus: A Case Report and Review of the Literature. Cureus 2023; 15:e44311. [PMID: 37779762 PMCID: PMC10535718 DOI: 10.7759/cureus.44311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Lemierre's syndrome, also known as anaerobic post-anginal septicemia, necrobacillosis, and the "forgotten disease," is a rare manifestation. It is often presented with sepsis, sore throat, fever, neck pain, internal jugular vein thrombophlebitis/thrombosis, and septic emboli. The bacteria that are usually associated with the disease are Fusobacterium species, but it is also associated with Staphylococcus, Streptococcus, and other bacterial species. The diagnosis of Lemierre's syndrome is made based on evidence of septic thrombophlebitis, preceding oropharyngeal infection, and positive culture. Treatment usually consists of antibiotics directed toward the causative organism. The use of anticoagulation, although controversial, is shown to be beneficial by several studies. We describe a middle-aged patient who presented with a sore throat, neck pain, and dysphagia. Imaging of the neck and chest revealed right jugular thrombosis along with septic emboli in the lungs. The culture of the blood and pus drained from the peritonsillar abscess grew Streptococcus anginosus. In this study, we have illustrated the effective management of Lemierre's syndrome with antibiotics, anticoagulants, and needle aspiration of abscess.
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Affiliation(s)
- Nihar Jena
- Cardiovascular Medicine, Saint Joseph Mercy Oakland, Pontiac, USA
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Sapkota S, Shrestha S, Sharma S, Sapkota S, Solis LA, Kalla A. Fusobacterium bacteremia presenting with inferior mesenteric vein thrombosis. Clin Case Rep 2023; 11:e7617. [PMID: 37397578 PMCID: PMC10310899 DOI: 10.1002/ccr3.7617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 07/04/2023] Open
Abstract
Isolated mesenteric vein thrombosis associated with Fusobacterium is rare. Physicians should be aware regarding the association of Fusobacterium with thrombosis at various sites.
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Affiliation(s)
| | - Suraj Shrestha
- Maharajgunj Medical CampusInstitute of MedicineKathmanduNepal
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Im DCS, Sridhar V, Lanks CW. Lemierre's Syndrome Associated With Papillary Thyroid Cancer and Cerebellar Stroke. Cureus 2023; 15:e38889. [PMID: 37180541 PMCID: PMC10174344 DOI: 10.7759/cureus.38889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 05/16/2023] Open
Abstract
A 53-year-old woman with no past medical history presented to the Emergency Department with right frontal headache and ipsilateral neck pain. She was found to have right internal jugular vein thrombosis, right cerebellar stroke, meningitis, septic pulmonary emboli, and fusobacterium bacteremia, all consistent with a severe presentation of Lemierre's syndrome (LS). While LS is often preceded by nasopharyngeal infection, no such history was elicited from our patient. Instead, concomitant papillary thyroid cancer with extension to her right internal jugular vein was implicated. Prompt recognition of these multiple related processes led to a timely initiation of appropriate therapy for infection, stroke, and malignancy.
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Affiliation(s)
- Dan C S Im
- Emergency Medicine, Harbor University of California Los Angeles Medical Center, Los Angeles, USA
| | - Vishaal Sridhar
- Pulmonary and Critical Care Medicine, Harbor University of California Los Angeles Medical Center, Los Angeles, USA
| | - Charles W Lanks
- Pulmonary and Critical Care Medicine, Harbor University of California Los Angeles Medical Center, Los Angeles, USA
- Pulmonary and Critical Care Medicine, Lundquist Institute for Biomedical Innovation, Torrance, USA
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ATAŞ İ, BİLİR Ö, ÜNLÜ A, TAŞÇI F. Lemierre's Syndrome: A Case Report. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2021. [DOI: 10.33706/jemcr.838532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Laurencet ME, Rosset-Zufferey S, Schrenzel J. Atypical presentation of Lemierre's syndrome: case report and literature review. BMC Infect Dis 2019; 19:868. [PMID: 31638919 PMCID: PMC6805316 DOI: 10.1186/s12879-019-4538-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The classic Lemierre's syndrome refers to a septic thrombosis of the internal jugular vein, usually caused by a Fusobacterium necrophorum infection starting in the oral cavity, and typically complicated by pulmonary emboli. However, unusual forms of the disorder have been rarely reported. CASE PRESENTATION We describe an unusual case of a previously healthy 58-year-old male with Lemierre's syndrome, manifesting with lumbar pain and fever. A thrombosis of the iliac veins and abscesses in the right iliac and the left psoas muscles was diagnosed by a computed tomography scan, together with a right lung pneumonia complicated by pleural effusion and an L4-L5 spondylodiscitis. Blood culture and pus drainage were positive for Fusobacterium nucleatum and an atypical Lemierre's syndrome was suspected. The patient was treated with anticoagulant therapy for 12 weeks and intravenous antibiotic therapy for 6 weeks with a good evolution and resolution of the thrombosis. CONCLUSIONS This case illustrates the thrombogenic and thromboembolic tendency of Fusobacterium nucleatum and its potential invasiveness, regardless of the site of primary infection. The concept of an atypical Lemierre's syndrome is redefined here to take into consideration non-cervical sites.
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Affiliation(s)
- Marie-Eva Laurencet
- Service of General and Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sarah Rosset-Zufferey
- Service of General and Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jacques Schrenzel
- Service of Infectious Diseases, Department of Medicine, Geneva University Hospitals and the University of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva 14, Switzerland. .,Bacteriology Laboratory, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland.
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Camacho-Cruz J, Preciado H, Beltrán N, Fierro L, Carrillo J. Lemierre's Syndrome Caused by Streptococcus anginosus Presenting as Postseptal Cellulitis in a Pediatric Patient. ORL J Otorhinolaryngol Relat Spec 2019; 81:234-239. [PMID: 31315119 DOI: 10.1159/000500560] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/23/2019] [Indexed: 11/19/2022]
Abstract
Lemierre's syndrome is an infrequent disease characterized by septic thrombosis of the internal jugular vein followed by pulmonary embolism generally occurring after upper respiratory and gastrointestinal tract infections. We present the case of a 15-year-old female patient with postseptal cellulitis and cervical abscess who developed pulmonary embolism and pleural effusion secondary to internal jugular vein thrombosis. Cultures were positive for Streptococcus anginosus, antibiotic treatment was established with satisfactory clinical outcome. High clinical suspicion is required for a diagnosis. The mainstay of treatment is a multidisciplinary approach based on two essential pillars: antibiotic therapy and surgical drainage. This is an important case because of the unusual presentation, the isolation of an infrequent pathogen, and the primary infection site (postseptal cellulitis), which are rare characteristics of this condition in the pediatric population.
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Affiliation(s)
- Jhon Camacho-Cruz
- School of Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia, .,Department of Pediatrics, Hospital de San José, Bogotá, Colombia,
| | - Helen Preciado
- School of Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia.,Department of Pediatrics, Hospital de San José, Bogotá, Colombia
| | - Natalia Beltrán
- School of Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia.,Department of Pediatrics, Hospital de San José, Bogotá, Colombia
| | - Laura Fierro
- School of Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia.,Department of Radiology, Hospital de San José, Bogotá, Colombia
| | - Jorge Carrillo
- School of Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia.,Department of Radiology, Hospital de San José, Bogotá, Colombia
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Zhao A, Samannodi M, Tahir M, Bensman S, Hocko M. Lemierre's syndrome: Case report and brief literature review. IDCases 2017; 10:15-17. [PMID: 28808620 PMCID: PMC5552024 DOI: 10.1016/j.idcr.2017.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/23/2017] [Accepted: 07/24/2017] [Indexed: 01/26/2023] Open
Abstract
Lemierre’s syndrome has been shown to be increasing in incidence in the past 20 years with one popular suggesting that said rise occurred from less aggressive antibacterial coverage. We report a case of Lemierre’s syndrome and also reviewed the 15 most recent case reports. A previously healthy 25 year old male who initially developed sore throat and flu-like symptoms, was prescribed antibacterials as an outpatient but was hospitalized for worsening symptoms. He was later diagnosed with Lemierre’s syndrome and improved clinically with IV antimicrobials alone. From our concise literature review, we determined that a decrease in antibiotic prescriptions may not fully explain why the incidence of Lemierre’s has been increasing. Thus, future research should be focused in evaluating possible worsening susceptibilities to antibiotics and improvements on detection. We also advise physicians to be aware of the signs and symptoms of this rare but potentially fatal condition as well as the available detection methods and treatment
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Affiliation(s)
- Andrew Zhao
- Mayo Clinic Health System - Franciscan Healthcare, 815 10th Street, South La Crosse, WI, 54601, United States
| | | | - Muhammad Tahir
- Department of medicine, Catholic Health System, University at Buffalo
| | - Sarah Bensman
- Department of medicine, Catholic Health System, University at Buffalo
| | - Michael Hocko
- Department of medicine, Catholic Health System, University at Buffalo
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