1
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Sah A, Sofia D, Vohra C, Chopra A. A 36-Year-Old Male With Left-Sided Neck Pain and Progressive Dyspnea. Chest 2024; 165:e169-e172. [PMID: 38852973 DOI: 10.1016/j.chest.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 06/11/2024] Open
Abstract
CASE PRESENTATION A 36-year-old male with no significant medical history presented to the ED with progressive left-sided neck and facial pain for the last 7 days. The patient also reported subjective fevers, chills, difficulty opening his mouth, and anorexia for the last 1 week. He denied cough, chest pain or tightness, shortness of breath, skin rashes, dysphagia, or odynophagia. He reported use of two to three 59.15 mL beers daily for the last 20 years. There was no recent travel or sick contact exposure. He did not report any TB exposure, IV drug use, or recent sexual encounters.
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Affiliation(s)
- Anuraag Sah
- Pulmonary and Critical Care Medicine, Albany Medical Center Hospital, Albany, NY.
| | - Daniel Sofia
- Internal Medicine, Albany Medical Center Hospital, Albany, NY
| | - Chirag Vohra
- All Indian Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Amit Chopra
- Pulmonary and Critical Care Medicine, Albany Medical Center Hospital, Albany, NY
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2
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Rajmohan S, Gao C, Chacon Garcia M, Miglior I, Pitkin L. Lemierre's Syndrome Secondary to Shoulder Hematoma Complicated by COVID-19: A Case Report. EAR, NOSE & THROAT JOURNAL 2024; 103:125S-129S. [PMID: 38078435 DOI: 10.1177/01455613231215166] [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: 12/22/2023] Open
Abstract
This case report illustrates a unique presentation of Lemierre's syndrome precipitated by Fusobacterium necrophorum. This case report describes a 20-year-old patient who developed Lemierre's syndrome secondary to a shoulder hematoma and neck abscess with multiple systemic complications in the absence of tonsillitis or oropharyngeal infection. Two weeks prior to presentation, the patient sustained a right shoulder injury and contracted COVID-19. Due to his Lemierre's syndrome, he developed right internal jugular vein and subclavian vein thrombosis, septic lung emboli, right sided Horner's syndrome, disseminated intravascular coagulation, pelvic collection, septic arthritis of pubic symphysis and osteomyelitis of the right pubic bone, and proximal left femoral shaft. The patient received non-operative and operative management to manage his Lemierre's syndrome including surgical drainage, antibiotics, and anticoagulation; he was discharged following an extended hospital stay. This case report highlights a rare presentation of Lemierre's syndrome secondary to a shoulder hematoma in a COVID-19 positive patient, and its potential systemic and life-threatening complications. Its importance is highly relevant in the context of the COVID-19 pandemic. Further studies are warranted to explore the effect of preceding COVID-19 infections on the microbiological profile in Lemierre's syndrome.
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Affiliation(s)
| | - Chuanyu Gao
- ENT Department, Royal Surrey County Hospital, Guildford, UK
| | | | - Isabel Miglior
- ENT Department, Royal Surrey County Hospital, Guildford, UK
| | - Lisa Pitkin
- ENT Department, Royal Surrey County Hospital, Guildford, UK
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3
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Chaudhari P, Sawant R, Bedi GN, Desale R, Kumar S, Acharya S. Case Report on Mycobacterium tuberculosis Presenting As Lemierre's Syndrome: A Reemerging Catastrophe. Cureus 2024; 16:e56353. [PMID: 38633960 PMCID: PMC11021875 DOI: 10.7759/cureus.56353] [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: 02/25/2024] [Accepted: 03/16/2024] [Indexed: 04/19/2024] Open
Abstract
Lemierre's syndrome is characterized by internal jugular vein thrombophlebitis and bacteremia, primarily from anaerobic organisms. The condition usually arises after a recent oropharyngeal infection. Young, healthy people with prolonged pharyngitis that progresses into septicemia, pneumonia, or lateral neck stiffness should be suspected of having Lemierre's syndrome. Identifying internal jugular vein thrombophlebitis and developing anaerobic bacterial growth on blood culture are frequently used to confirm the diagnosis. Treatment consists of long-term antibiotic treatment, sometimes in conjunction with anticoagulant medication. In this case report, we describe the unique case of a 29-year-old male with Mycobacterium tuberculosis with pulmonary tuberculosis, tubercular meningitis, tuberculosis-related acute ischemic stroke with septic thrombophlebitis. The patient presented with sudden onset altered sensorium for 4 hours. Magnetic resonance imaging of the brain was done, which suggested obstructive hydrocephalus with periventricular ooze. The patient was started on antibacillary treatment, antibiotics, anticoagulants, and systemic steroids. The patient was vitally stable when he was discharged. Therefore, it is crucial to consider the likelihood of such atypical tuberculosis presentations while providing a prompt and relevant diagnosis and recommending the right course of therapy.
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Affiliation(s)
| | - Rucha Sawant
- Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Gautam N Bedi
- Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Rahul Desale
- Interventional Radiology, Jawaharlal Nehru Medical College, Wardha, IND
| | - Sunil Kumar
- Medicine, Jawaharlal Nehru Medical College, Wardha, IND
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4
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Sharma A, Mahajan Z, Mehta S, Puri A. Lemierre syndrome: a diagnostic dilemma of critical care in the post-COVID era. BMJ Case Rep 2024; 17:e257143. [PMID: 38216157 PMCID: PMC10806918 DOI: 10.1136/bcr-2023-257143] [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: 01/14/2024] Open
Abstract
Lemierre syndrome (LS) is referred to as the 'forgotten Disease' owing to its rarity in the postantibiotic era with an estimated yearly incidence of 1/million population. The classic triad of LS includes internal jugular vein thrombosis, oropharyngeal infection and metastatic septic emboli. We present a case of typical LS with Fusobacterium and Prevotella infection, presenting with peritonsillar abscess and jugular vein thrombosis complicated by sepsis, acute hypoxic respiratory failure due to multiple pulmonary emboli and severe thrombocytopaenia in the absence of disseminated intravascular coagulation.
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Affiliation(s)
- Akhya Sharma
- Internal Medicine, Loyola University Chicago, Chicago, Illinois, USA
| | - Zubin Mahajan
- Internal Medicine, Loyola University Chicago, Chicago, Illinois, USA
| | - Sameera Mehta
- Pathology, Smt Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Aditi Puri
- Internal Medicine, Loyola University Chicago, Chicago, Illinois, USA
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5
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Jassal SS, Steen C, Wong E. Lemierre syndrome causing empyema and pulmonary embolism: A reemerging disease from a bygone era? Clin Case Rep 2023; 11:e8244. [PMID: 38033700 PMCID: PMC10682232 DOI: 10.1002/ccr3.8244] [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: 06/09/2023] [Revised: 09/30/2023] [Accepted: 11/04/2023] [Indexed: 12/02/2023] Open
Abstract
Long considered a "forgotten disease" of a bygone era, the apparent reemergence of Lemierre syndrome highlights the need for awareness of this rare condition to ensure timely diagnosis and treatment. Lemierre syndrome should be suspected in young adults presenting with a chest or neck infection and requires prolonged antibiotic therapy, surgical drainage of collections, and often anticoagulation.
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Affiliation(s)
- Shalvin Singh Jassal
- General Surgery UnitBox Hill Hospital (Eastern Health)MelbourneVictoriaAustralia
| | - Christopher Steen
- General Surgery UnitBox Hill Hospital (Eastern Health)MelbourneVictoriaAustralia
- Monash UniversityMelbourneVictoriaAustralia
| | - Enoch Wong
- General Surgery UnitBox Hill Hospital (Eastern Health)MelbourneVictoriaAustralia
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6
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Cheema RSP, Kler PK, Madu A, Macve J, MacDuff A. A man with culture sterile cavitating lung lesions: molecular techniques can provide the key to diagnosis. Access Microbiol 2023; 5:000510.v3. [PMID: 37841089 PMCID: PMC10569650 DOI: 10.1099/acmi.0.000510.v3] [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: 10/26/2022] [Accepted: 08/17/2023] [Indexed: 10/17/2023] Open
Abstract
A 20-year-old male presented to the Emergency Department with pyrexia, dyspnoea, chest pain and haemoptysis. Cavitating lung lesions were noted on chest X-ray and the patient was admitted to the intensive care unit where he was intubated and ventilated. Routine investigations including serial cultures did not provide an aetiological diagnosis. As such, a CT-guided lung biopsy was carried out and 16S rDNA PCR was undertaken on the sample. This identified Fusobacterium necrophorum as the causative organism. The patient was treated for Lemierre's syndrome and successfully discharged from hospital. This case highlights how DNA tissue typing on a lung biopsy sample can be the key to successful diagnosis in an atypical pneumonia and raises the question as to whether this infrequently used approach should be added to forthcoming community acquired pneumonia guidelines.
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Affiliation(s)
- Ranvir S. P. Cheema
- Department of Critical Care, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton Road, WV10 OQP, UK
| | - Prabhjoyt K. Kler
- Department of Critical Care, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton Road, WV10 OQP, UK
| | - Alpha Madu
- Department of Critical Care, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton Road, WV10 OQP, UK
| | - Joanna Macve
- Department of Microbiology, Black Country Pathology Services, The Royal Wolverhampton NHS Trust, Wolverhampton Road, Wolverhampton, WV10 OQP, UK
| | - Andrew MacDuff
- Department of Critical Care, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton Road, WV10 OQP, UK
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7
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Chen TA, Chuang YT, Lin HY, Chen CH. Lemierre's Syndrome Caused by Klebsiella pneumoniae: A Case Report and Literature Review. Cureus 2023; 15:e44434. [PMID: 37664341 PMCID: PMC10469873 DOI: 10.7759/cureus.44434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 09/05/2023] Open
Abstract
Lemierre's syndrome is a rare condition that involves anaerobic sepsis following pharyngitis and is characterized by a high mortality rate. It often manifests as a septic embolism within the internal jugular vein due to oropharyngeal infections, leading to vein wall inflammation. Despite modern antibiotics, Lemierre's syndrome remains underdiagnosed and poses a significant threat. We report the case of a 43-year-old man who has alcoholic liver cirrhosis and diabetes mellitus. Symptoms included chest pain, back pain, and neck swelling, with Klebsiella pneumoniae leading to the diagnosis of K. pneumoniae-associated Lemierre's syndrome. Furthermore, K. pneumoniae-associated Lemierre's syndrome is linked to diabetes mellitus and the elderly population. Notably, it showed a tendency for distant metastases, particularly in the lungs and brain. Additionally, central nervous system and renal involvement were observed in a smaller subset of cases.
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Affiliation(s)
- Tao An Chen
- Division of Respiratory Therapy, Department of Chest Medicine, Show Chwan Memorial Hospital, Changhua, TWN
| | - Ya Ting Chuang
- Surgical Intensive Care Unit, Department of Nursing, Show Chwan Memorial Hospital, Changhua, TWN
| | - Hua Yu Lin
- Surgical Intensive Care Unit, Department of Nursing, Show Chwan Memorial Hospital, Changhua, TWN
| | - Cheng Hsien Chen
- Department of Surgery, Show Chwan Memorial Hospital, Changhua, TWN
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8
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Tiwari A. Lemierre's Syndrome in the 21st Century: A Literature Review. Cureus 2023; 15:e43685. [PMID: 37724228 PMCID: PMC10505273 DOI: 10.7759/cureus.43685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/20/2023] Open
Abstract
Lemierre's syndrome is a rare, life-threatening complication of an acute oropharyngeal infection. It is generally characterised by pharyngitis secondary to Fusobacterium necrophorum, causing thrombophlebitis of the internal jugular vein and sepsis, with subsequent formation of septic emboli that can rapidly spread to different organ sites. The condition is associated with high mortality if treatment with antibiotics is delayed, and recent evidence suggests that patients are at significant risk of in-hospital morbidity and long-term neurological sequelae. Although it is agreed that antibiotics are the mainstay of treatment, there is currently no consensus on the use of anticoagulation in the condition. This review article aims to summarise our current understanding of Lemierre's syndrome with regard to its definition, epidemiology, microbiology, presentation, diagnosis, and treatment.
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Affiliation(s)
- Abhinav Tiwari
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
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9
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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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10
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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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11
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Ojeniyi SO, Ibukun F, Kanemo P. Lemierre's Syndrome (LS) Complicated by Cranial Nerve XII Palsy. Cureus 2023; 15:e38181. [PMID: 37252571 PMCID: PMC10220427 DOI: 10.7759/cureus.38181] [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: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Lemierre's syndrome (LS) is a rare medical condition that involves an acute oropharyngeal infection leading to septic thrombophlebitis of the internal jugular vein with embolic spread to organs like the kidneys, lungs, and large joints. Only very little literature has reported central nervous system involvement with LS. This is a case of 34-year-old woman with right-sided neck pain, swallowing difficulties, and a sore throat of 3 days duration at the time of presentation. CT of the neck with contrast showed a ruptured right peritonsillar abscess and thrombus in the right internal jugular vein suspicious of thrombophlebitis. The patient was managed for LS with IV antibiotics and anticoagulation. However, her clinical course was complicated by cranial nerve XII palsy, which is an extremely rare manifestation of LS.
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Affiliation(s)
| | - Francis Ibukun
- Internal Medicine, MedStar Union Memorial Hospital, Baltimore, USA
| | - Philip Kanemo
- Internal Medicine, Rapides Regional Medical Center, Alexandria, USA
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12
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El Hajj R, Stanzelova A, de Marcellus C, Kossorotoff M, Remangeon F, Roux CJ, Touzé R, Toubiana J, Benaboud S, Oualha M, Moulin F, Collignon C. Severe atypical Lemierre syndrome caused by methicillin-sensitive Staphylococcus aureus: Two pediatric case reports. Arch Pediatr 2023:S0929-693X(23)00037-4. [PMID: 36990936 DOI: 10.1016/j.arcped.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 02/12/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Lemierre syndrome is typically associated with ear, nose, and throat (ENT) infections caused by Fusobacterium necrophorum. Since 2002, cases of atypical Lemierre-like syndrome secondary to Staphylococcus aureus have been reported. CASES We report two pediatric cases of atypical Lemierre syndrome with a similar presentation: exophthalmia, absence of pharyngitis, metastatic lung infection, and intracranial venous sinus thrombosis. Both patients had a favorable outcome following treatment with antibiotics, anticoagulation, and corticosteroids. CONCLUSION Regular therapeutic monitoring of antibiotic levels helped to optimize antimicrobial treatment in both cases.
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Affiliation(s)
- R El Hajj
- Pediatrics, André Mignot Hospital, Versailles, France
| | - A Stanzelova
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker-Enfants Malades University Hospital, Paris, France; Université de Paris Cité, Paris, France
| | - C de Marcellus
- Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France
| | - M Kossorotoff
- Pediatric Neurology, APHP University Hospital Necker-Enfants Malades, Paris, France
| | - F Remangeon
- Université de Paris Cité, Paris, France; Pediatric Otorhinolaryngology Department, APHP, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - C-J Roux
- Pediatric Radiology, APHP University Hospital Necker-Enfants Malades, Paris, France
| | - R Touzé
- Ophthalmology Department and Reference Center for Rare Ophthalmological Diseases (OPHTARA), AP-HP, University Hospital Necker-Enfants Malades, Paris, France; Université de Paris Cité, Paris, France
| | - J Toubiana
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker-Enfants Malades University Hospital, Paris, France; Université de Paris Cité, Paris, France
| | - S Benaboud
- Pharmacology Department, Cochin Hospital, AP-HP Centre-Université de Paris, Paris, France
| | - M Oualha
- Université de Paris Cité, Paris, France; Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France
| | - F Moulin
- Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France
| | - C Collignon
- Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France.
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13
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Amos D, Collins J, Walker DT. Monkeypox presenting as supraglottitis in an immunocompromised patient. BMJ Case Rep 2023; 16:e252213. [PMID: 36737067 PMCID: PMC9899981 DOI: 10.1136/bcr-2022-252213] [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: 02/05/2023] Open
Abstract
We describe a young man with AIDS who presented to the ear, nose and throat team with a severe sore throat mimicking supraglottitis. He had a 3-day history of sore throat, hoarse voice, fevers and myalgia. On examination, he had cervical lymphadenopathy and profuse pus overlying his right tonsil. On flexible nasoendoscopy, this pus was seen to track down to the supraglottis, with associated mucosal ulceration. The patient was treated for supraglottitis and he improved. 24 hours postadmission, a pustule suspicious for monkeypox developed on the patient's hand. The diagnosis was confirmed by PCR testing. The patient was isolated and treated supportively and recovered fully. This case highlights that monkeypox may present with a severe sore throat without cutaneous lesions. Monkeypox is a growing public health concern . Its early symptoms are non-specific and healthcare professionals should be alert to it.
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Affiliation(s)
- Dora Amos
- Otolaryngology, Royal Surrey County Hospital, Guildford, UK
| | | | - David T Walker
- Otolaryngology Department, Royal Surrey NHS Foundation Trust, Guildford, UK
- ENT Deparment, Basingstoke and North Hampshire Hospital, Basingstoke, UK
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14
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Silverberg B, Sharon MJ, Makati D, Mott M, Rose WD. Forget-me-not: Lemierre's syndrome, a case report. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:343-347. [PMID: 33760711 DOI: 10.1080/07448481.2021.1899190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/12/2021] [Accepted: 02/28/2021] [Indexed: 06/12/2023]
Abstract
Background: Familiarity breeds complacency. One case of sore throat can start to sound like another. However, even common viral and bacterial infections can lead to serious sequelae. Clinicians cannot make a diagnosis if they do not consider it in their differential.Case: The presentation - and subsequent hospitalization - of a septic 19 year-old male college student is described. Despite brief interval improvement, he became hypoxic one week after developing a sore throat and was ultimately diagnosed with Lemierre's syndrome (septic thrombophlebitis of the internal jugular vein) via blood cultures and advanced imaging.Conclusions: Though rare, Lemierre's syndrome carries a high mortality rate. It should be considered an emergent complication of head and neck infections, particularly in young adults.
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Affiliation(s)
- Benjamin Silverberg
- Division of Ambulatory Care, Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Melinda J Sharon
- Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Devan Makati
- Section of Nephrology, Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Mariah Mott
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - William D Rose
- Division of Ambulatory Care, Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
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15
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Sanivarapu RR, Rajamreddy RS, Nalla S, Shaik Masthan S, Mangu G. Lemierre's Syndrome in the External Jugular Vein Precipitated by COVID-19 Infection. Cureus 2023; 15:e34512. [PMID: 36874340 PMCID: PMC9984202 DOI: 10.7759/cureus.34512] [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: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Lemierre's syndrome is a condition when an oropharyngeal infection, typically from Fusobacterium necrophorum, causes thrombophlebitis of the internal jugular vein. There have been few case reports of Lemierre's syndrome affecting the external jugular vein, but to our knowledge, this is the first case report where COVID-19 infection is the prime suspect for causing this syndrome. SARS-CoV-2 infection, known to cause hypercoagulability and immunosuppression, increases the risk of deep venous thrombosis and secondary infections. We report a case of a young male with no known risk factors who developed Lemierre's syndrome as a complication of COVID infection.
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Affiliation(s)
- Raghavendra R Sanivarapu
- Pulmonary and Critical Care Medicine, Texas Tech University Health Sciences Center, Odessa, USA.,Pulmonary and Critical Care Medicine, Nassau University Medical Center, East Meadow, USA
| | - Ramya Sruthi Rajamreddy
- Internal Medicine, People's Education Society Institute of Medical Sciences and Research (PESIMSR), Kuppam, IND
| | - Swetha Nalla
- Internal Medicine, Mamata Medical College, Khammam, IND
| | | | - Goutami Mangu
- Internal Medicine, Texas Tech University Health Sciences Center, Odessa, USA
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16
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Bista PK, Pillai D, Roy C, Scaria J, Narayanan SK. Comparative Genomic Analysis of Fusobacterium necrophorum Provides Insights into Conserved Virulence Genes. Microbiol Spectr 2022; 10:e0029722. [PMID: 36219094 PMCID: PMC9769765 DOI: 10.1128/spectrum.00297-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 09/16/2022] [Indexed: 01/05/2023] Open
Abstract
Fusobacterium necrophorum is a Gram-negative, filamentous anaerobe prevalent in the mucosal flora of animals and humans. It causes necrotic infections in cattle, resulting in a substantial economic impact on the cattle industry. Although infection severity and management differ within F. necrophorum species, little is known about F. necrophorum speciation and the genetic virulence determinants between strains. To characterize the clinical isolates, we performed whole-genome sequencing of four bovine isolates (8L1, 212, B17, and SM1216) and one human isolate (MK12). To determine the phylogenetic relationship and evolution pattern and investigate the presence of antimicrobial resistance genes (ARGs) and potential virulence genes of F. necrophorum, we also performed comparative genomics with publicly available Fusobacterium genomes. Using up-to-date bacterial core gene (UBCG) set analysis, we uncovered distinct Fusobacterium species and F. necrophorum subspecies clades. Pangenome analyses revealed a high level of diversity among Fusobacterium strains down to species levels. The output also identified 14 and 26 genes specific to F. necrophorum subsp. necrophorum and F. necrophorum subsp. funduliforme, respectively, which could be essential for bacterial survival under different environmental conditions. ClonalFrameML-based recombination analysis suggested that extensive recombination among accessory genes led to species divergence. Furthermore, the only strain of F. necrophorum with ARGs was F. necrophorum subsp. funduliforme B35, with acquired macrolide and tetracycline resistance genes. Our custom search revealed common virulence genes, including toxins, adhesion proteins, outer membrane proteins, cell envelope, type IV secretion system, ABC (ATP-binding cassette) transporters, and transporter proteins. A focused study on these genes could help identify major virulence genes and inform effective vaccination strategies against fusobacterial infections. IMPORTANCE Fusobacterium necrophorum is an anaerobic bacterium that causes liver abscesses in cattle with an annual incidence rate of 10% to 20%, resulting in a substantial economic impact on the cattle industry. The lack of definite biochemical tests makes it difficult to distinguish F. necrophorum subspecies phenotypically, where genomic characterization plays a significant role. However, due to the lack of a good reference genome for comparison, F. necrophorum subspecies-level identification represents a significant challenge. To overcome this challenge, we used comparative genomics to validate clinical test strains for subspecies-level identification. The findings of our study help predict specific clades of previously uncharacterized strains of F. necrophorum. Our study identifies both general and subspecies-specific virulence genes through a custom search-based analysis. The virulence genes identified in this study can be the focus of future studies aimed at evaluating their potential as vaccine targets to prevent fusobacterial infections in cattle.
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Affiliation(s)
- Prabha K. Bista
- Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, USA
| | - Deepti Pillai
- Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, USA
- Indiana Animal Disease and Diagnostic Laboratory, Purdue University, West Lafayette, Indiana, USA
| | - Chayan Roy
- Department of Veterinary and Biomedical Sciences, South Dakota State University, Brookings, South Dakota, USA
- Environment Microbial Genomics, Plant and Environmental Microbiology, Copenhagen University, Copenhagen, Denmark
| | - Joy Scaria
- Department of Veterinary and Biomedical Sciences, South Dakota State University, Brookings, South Dakota, USA
| | - Sanjeev K. Narayanan
- Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, USA
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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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Muacevic A, Adler JR. Lemierre's Syndrome: A Lethal Complication of Acute Tonsillitis. Cureus 2022; 14:e30072. [PMID: 36381870 PMCID: PMC9639786 DOI: 10.7759/cureus.30072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/08/2022] [Indexed: 12/05/2022] Open
Abstract
Tonsillitis is a condition involving the infection of the lymphoid tissue of the tonsils. This pathology of the tonsils is frequently reported as a childhood illness in children of school-going age. The leading causative agent which is associated with tonsillitis is Group A and B Haemolytic Streptococcus and Staphylococcus and Haemophilus influenzae. With rapid and correct treatment and management with antibiotics and analgesics, it can be resolved, and the patient can be free of the symptoms such as sore throat, dysphagia, pain over the throat, and fever. Though in the minority of cases the diseases can progress and can result in multiple complications which sometimes can be lethal and extremely serious. These can be rheumatic fever, acute glomerulonephritis, or tonsillar cyst. One of the sporadic but equally important and grave syndromes is Lemierre's syndrome, which unfortunately has been labelled as a forgotten disease due to the development of antibiotic therapy and management of the disease. The mortality of the disease was extremely high in the pre-antibiotic era. This disease presents the following findings, such as thrombophlebitis of the internal jugular vein, which usually occurs after the presentation of pharyngeal infection. Which in later stages also gives rise to thrombi that advance and extend throughout the body, in the form of septic emboli. The important microorganism which is isolated and associated with the Lemierre's is Fusobacterium necrophorum, a strict gram-negative anaerobe. This article emphasizes and discusses the pathophysiology, and microbiology of Lemierre's syndrome. It also focuses on the clinical symptoms that include the appropriate and timely diagnosis and treatment of this deadly and fatal syndrome, together with the complications that arise with Lemierre's syndrome as the presenting problem.
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19
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Ibrahim IG, Osman AA, Elmi AM, Küsbeci M, Ali Jama SM, Ali AY, Farah FA. Lemierre's syndrome with cranial epidural abscess complication: A case report. Ann Med Surg (Lond) 2022; 81:104478. [PMID: 36147177 PMCID: PMC9486728 DOI: 10.1016/j.amsu.2022.104478] [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] [Received: 06/22/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Lemierre's syndrome is a rare disease typically manifested by thrombophlebitis of the jugular vein and septic embolism following a history of oropharyngeal infection. Fusobacterium necrophorum is the causative agent of Lemierre syndrome, commonly known as post-anginal sepsis. Case presentation We reported a 24-year-old male who came to the emergency department complaining of a history of a sore throat, fever, malaise, fever, and neck swelling with a normal consciousness level. A laboratory examination showed leukocytosis and high C-reactive protein serum. Radiological diagnosis reveals an anterior neck abscess with left jugular vein thrombosis and left epidural abscess. The blood culture was positive for Fusobacterium necrophorum. The patient underwent surgical drainage and, at the same time, was treated with antibiotics and anticoagulant drugs. After 45 days, the patient improved clinically and was discharged. There were no other symptoms after a one-month follow-up clinically and neck ultrasonography. Clinical discussion Lemierre's syndrome has historically had a high mortality rate, approximately up to 90% before antibiotics. The disease's incidence has declined gradually, leading it to become recognized as the “forgotten disease.” Nevertheless, the incidence of Lemierre syndrome has been increasing over the last twenty to thirty years. Primary oropharyngeal infection, bacteremia, radiographic or clinical evidence of internal jugular vein thrombosis, and septic metastatic foci are the main clinical hallmarks of Lemierre's syndrome. Surgical debridement, antibiotics, and anticoagulants are the treatments of choice. Conclusion Lemierre's syndrome with cranial epidural abscess is very rare. It is a forgotten disease. Nowadays, the prevalence is increasing. Awareness of clinical and radiological features will aid the prompt management of patients. Lemierre's syndrome with cranial epidural abscess is a rare disease that mostly affects young adults and is commonly caused by Fusobacterium necrophorum. A clinical manifestation characterized by jugular vein thrombosis and septic embolism following a history of oropharyngeal infection. It is a forgotten disease. Nowadays, the prevalence is increasing. Awareness of clinical and radiological features will aid the prompt management of patients.
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Affiliation(s)
- Ismail Gedi Ibrahim
- Department of Radiology Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
- Corresponding author.
| | - Ahmed Adam Osman
- Department of Radiology Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Abdinasir Mohamed Elmi
- Department of Radiology Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Mahmut Küsbeci
- Department of Radiology Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Shuayb Moallim Ali Jama
- Department of Radiology Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Abdullahi Yusuf Ali
- Department of Pediatric Surgery Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Faiza Abdulkadir Farah
- Department of ENT Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
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King JP, Matthews L, Ashai S. Atypical presentation of Lemierre syndrome in a young healthy man with acute jaundice. BMJ Case Rep 2022; 15:e249824. [PMID: 36129352 PMCID: PMC9438057 DOI: 10.1136/bcr-2022-249824] [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: 11/04/2022] Open
Abstract
This report presents a case of Lemierre syndrome caused by Fusobacterium necrophorum in a healthy young adult who presented atypically with shortness of breath and jaundice but no clinical or diagnostic evidence of thrombophlebitis. Due to this unusual presentation with jaundice, diagnosis was challenging and delayed. However, the patient was successfully initiated on a prolonged course of intravenous antibiotics; he required a period in the intensive care unit and was discharged without significant complications. This report aims to raise awareness of the diagnosis and treatment of this rare condition and to highlight both common and unusual presentations of the syndrome.
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Affiliation(s)
| | - Lauren Matthews
- Jack Steinberg Critical Care Unit, King's College Hospital, London, UK
| | - Shanze Ashai
- Jack Steinberg Critical Care Unit, King's College Hospital, London, UK
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21
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Ueno K, Horiuchi H, Utada S, Shinomiya Y, Sogo A, Miyagawa T, Niida S, Okano H, Suzuki N, Otsuka T, Miyazaki H, Furuya R. Lemierre’s Syndrome as a Sexually Transmitted Disease Due to Porphyromonas asaccharolytica Suspected to Be Caused by Pharyngitis Due to Mycoplasma pneumoniae and Epstein-Barr Virus. Cureus 2022; 14:e28219. [PMID: 36158393 PMCID: PMC9485779 DOI: 10.7759/cureus.28219] [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] [Accepted: 08/20/2022] [Indexed: 11/22/2022] Open
Abstract
Porphyromonas asaccharolytica rarely causes Lemierre's syndrome (LS), which is characterised by sepsis and thrombophlebitis of the internal jugular vein. An 18-year-old man presented with fever and a sore throat after sexual contact containing oral sex, and his blood sample was positive for atypical lymphocytes. Infectious mononucleosis was suspected initially. However, laboratory data showed elevated D-dimer and procalcitonin levels, and a computed tomography scan showed a thrombus in the internal jugular vein leading to the diagnosis of LS. The Mycoplasma pneumoniae (MP) IgM titre was 1:640 (normal, ≦1:40), and the Epstein-Barr nuclear antigen titre (taken 59 days after admission) was 1:10 (normal, <1:10). It was assumed that LS developed after infection with Epstein-Barr virus (EBV) and MP. LS should be suspected in young patients with fever and sore throat with a history of recent sexual contact. As pharyngitis was considered the cause of LS, evaluation of the preceding infection such as MP or EBV leading to pharyngitis should also be considered.
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22
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Toner MB, Molloy S, Mallett P, Thompson A, Speirs L. A common complaint… a rare disease! Arch Dis Child Educ Pract Ed 2022; 107:268-270. [PMID: 33172868 DOI: 10.1136/archdischild-2020-320122] [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: 07/02/2020] [Accepted: 10/10/2020] [Indexed: 11/04/2022]
Abstract
A 2-year-old previously well child presented to the emergency department with temperatures and lethargy. He was pale and looked unwell. He received a fluid bolus and was commenced on intravenous ceftriaxone. Pus was discharging from his left ear with postauricular swelling and erythema. Given clinical concerns, urgent neuroimaging was arranged.
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Affiliation(s)
- Mary-Beth Toner
- Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Seana Molloy
- Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Peter Mallett
- Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
- Paediatric Infectious Diseases, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Andrew Thompson
- Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Lynne Speirs
- Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
- Paediatric Infectious Diseases, Royal Belfast Hospital for Sick Children, Belfast, UK
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23
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Case report of Lemierre's Syndrome associated with Fusobacterium nucleatum infection without internal or external jugular venous thrombophlebitis. Respir Med Case Rep 2022; 37:101651. [PMID: 35516791 PMCID: PMC9062341 DOI: 10.1016/j.rmcr.2022.101651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/08/2022] [Indexed: 12/04/2022] Open
Abstract
Fusobacterium nucleatum is an anaerobe that is commensal to the human oral cavity. It is usually a component of periodontal plaque that is emerging as a pathogen and quickly attracting attention of the medical and research communities. It has been even discovered in bronchoalveolar lavage of some patients with lung cancer. Lemierre's syndrome (LS) is characterized as septic thrombophlebitis of the internal jugular vein, which usually begins with oropharyngeal infection that worsens and leads to inflammation of the wall of the jugular vein. This is the hallmark of the disease. However, in this case, there was no thrombophlebitis of the internal jugular vein. There is one other case presentation where it was diagnosed without the internal jugular vein involvement. Most sequelae involve infected thrombus of the vein, soft tissue inflammation, persistent bacteremia, and septic emboli, often leading to metastatic infections. Interestingly enough, in the age of SARS-COV-2, LS has also been mistaken for multisystem inflammatory syndrome in children (MIS-C). We present a previously healthy 20-year-old female college student who was transferred from her local hospital to Bristol-Myers Squibb Children's Hospital (BMSCH) at Robert Wood Johnson University Hospital for suspected LS with loculated pleural effusions and necrotizing pneumonia with lung abscess secondary to Fusobacterium nucleatum, systemic and emphysematous osteomyelitis possibly secondary to septic emboli, thrombocytopenia, and palatine tonsil and thyroid abscesses.
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24
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Ko YC, Tsai MS, Ong HN, Huang CH, Wu SN, Chang WT, Chen WT. A 57-Year-Old Woman With Fever, Urinary Frequency, and Shock. Chest 2022; 161:e191-e193. [PMID: 35256096 PMCID: PMC8894720 DOI: 10.1016/j.chest.2021.05.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/30/2021] [Accepted: 05/29/2021] [Indexed: 10/28/2022] Open
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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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26
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McGovern M, Fried TB, Mangan J, Hilibrand AS. Paralysis: A Rare Presentation of Lemierre's Syndrome: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00048. [PMID: 36099469 DOI: 10.2106/jbjs.cc.21.00682] [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: 06/15/2023]
Abstract
CASE A patient presented with acute paralysis in the setting of undiagnosed Lemierre's syndrome. Streptococcus pyogenes was the causative organism leading to internal jugular vein thrombosis, sternocleidomastoid abscess, vertebral osteomyelitis, and epidural phlegmon. The patient was treated both surgically, with abscess evacuation, hemicorpectomy, and fusion, and medically, with antibiotics and anticoagulation. Postoperatively, the patient regained upper extremity strength and lower extremity sensation, but the paraplegia remained. CONCLUSION Lemierre's syndrome is a rare complication of oropharyngeal infection with a constellation of findings including jugular thrombophlebitis, metastatic abscesses, and frequent involvement of anaerobic pathogens that may present acutely with paralysis.
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Affiliation(s)
- Madeline McGovern
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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27
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Recchia A, Cascella M, Altamura S, Borrelli F, De Nittis N, Dibenedetto E, Labonia M, Pavone G, Del Gaudio A. Early Diagnosis and Antibiotic Treatment Combined with Multicomponent Hemodynamic Support for Addressing a Severe Case of Lemierre's Syndrome. Antibiotics (Basel) 2021; 10:antibiotics10121526. [PMID: 34943737 PMCID: PMC8698451 DOI: 10.3390/antibiotics10121526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/14/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022] Open
Abstract
A 20-year-old man was admitted to the intensive care unit for septic shock due to Lemierre’s syndrome. It is a rare syndrome that manifests as an upper respiratory infection, although systemic involvement, severe coagulopathy, and multi-organ failure can dangerously complicate the clinical picture. In this syndrome, sepsis-related neuroendocrine dysregulation and microcirculation impairment can have a rapid deleterious progression. Consequently, proper diagnosis, early source control, and appropriate antibiotics administration are mandatory to improve the prognosis. The intensive treatment is aimed at limiting organ damage through hemodynamic optimization. Remarkably, in septic shock due to Lemierre’s syndrome, hemodynamic optimization can be achieved through the synergic effect of norepinephrine, argipressin, and hydrocortisone.
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Affiliation(s)
- Andreaserena Recchia
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
- Correspondence: (A.R.); (M.C.); Tel.: +39-0882-4107-03 (A.R.)
| | - Marco Cascella
- Anesthesia and Pain Medicine Istituto Nazionale Tumori-IRCCS, Fondazione G. Pascale, 80100 Napoli, Italy
- Correspondence: (A.R.); (M.C.); Tel.: +39-0882-4107-03 (A.R.)
| | - Sabrina Altamura
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| | - Felice Borrelli
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| | - Nazario De Nittis
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| | - Elisabetta Dibenedetto
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| | - Maria Labonia
- Microbiology and Virology, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy;
| | - Giovanna Pavone
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| | - Alfredo Del Gaudio
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
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Jaber TM, Saini V, Ogbebor O, Dumont T, Balaan M, Lega M, Cheema T. Lemierre's Syndrome: A Case Series. Cureus 2021; 13:e18436. [PMID: 34737904 PMCID: PMC8559581 DOI: 10.7759/cureus.18436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 12/02/2022] Open
Abstract
Lemierre’s syndrome (LS) is a potentially fatal complication of oropharyngeal infection, resulting in contiguous suppurative thrombosis of the internal jugular vein (IJV) and septic emboli. It is most commonly associated with Fusobacterium necrophorum (F. necrophorum), though other pathogens have also been implicated in its pathogenesis. The incidence of LS had so significantly decreased that it was referred to as "the forgotten disease." However, cases of LS have shown a resurgence, which may be partly attributed to an overreliance on a negative group A beta-hemolytic streptococcal rapid antigen detection test (RADT), commonly referred to as "rapid strep test." Clinicians must maintain a very high index of suspicion for LS in patients with persistent sequelae from tonsillopharyngitis who have a negative RADT.
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Affiliation(s)
- Tariq M Jaber
- Infectious Disease & Critical Care, Allegheny Health Network, Pittsburgh, USA
| | - Vikram Saini
- Infectious Disease & Critical Care, Allegheny Health Network, Pittsburgh, USA
| | - Osakpolor Ogbebor
- Internal Medicine/Infectious Disease & Critical Care, Allegheny Health Network, Pittsburgh, USA
| | - Tiffany Dumont
- Pulmonary and Critical Care Medicine, Allegheny Health Network, Pittsburgh, USA
| | - Marvin Balaan
- Pulmonary and Critical Care Medicine, Allegheny General Hospital, Pittsburgh, USA
| | - Mark Lega
- Division of Pulmonary and Critical Care Medicine, Allegheny General Hospital, Pittsburgh, USA
| | - Tariq Cheema
- Pulmonary and Critical Care Medicine, Allegheny Health Network, Pittsburgh, USA
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29
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Said UN, Al-Hashimi KA. A Case of Embolic Spread of Fusobacterium necrophorum From Presumed Pharyngitis. Cureus 2021; 13:e18865. [PMID: 34692265 PMCID: PMC8525690 DOI: 10.7759/cureus.18865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/05/2022] Open
Abstract
Fusobacterium necrophorum is the most common pathogen isolated in individuals diagnosed with the rare and life-threatening illness known as Lemierre's syndrome. Lemierre's syndrome commonly involves a triad of infection in the oropharyngeal region, thrombophlebitis of the internal jugular vein, and distant metastases of said infection. Our case involves an embolic spread of F. necrophorum to the lungs, which was presumed to have originated in the pharynx, in the absence of internal jugular vein thrombosis. The clinical course of the patient was further complicated by an initial diagnosis of community-acquired pneumonia, severe sepsis, and disseminated intravascular coagulation. After suitable input from the multi-disciplinary team and adequate antibiotic therapy, the patient demonstrated a positive outcome with complete recovery to her baseline.
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Affiliation(s)
- Umar N Said
- Trauma and Orthopaedics, Huddersfield Royal Infirmary, Huddersfield, GBR
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30
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Liu A, Taylor J, Slavin M, Tong S. Severe case of Lemierre syndrome with multiple neurological and ophthalmological sequelae. BMJ Case Rep 2021; 14:e244669. [PMID: 34426431 PMCID: PMC8383858 DOI: 10.1136/bcr-2021-244669] [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] [Accepted: 07/31/2021] [Indexed: 11/03/2022] Open
Abstract
A 56-year-old man was admitted to intensive care with septic shock, multiple facial abscesses and thrombophlebitis of the right internal jugular vein with extensive intracranial extension. A diagnosis of Lemierre syndrome due to Streptococcus anginosus was made and treatment initiated with high-dose ceftriaxone and metronidazole, along with surgical debridement. His admission was complicated by raised intraocular pressures and visual loss requiring bilateral canthotomies. Despite therapeutic anticoagulation with enoxaparin, he also developed an ischaemic basal ganglia infarct. After a prolonged and complex hospital stay, the patient was later readmitted with an intracerebral abscess requiring surgical excision and a second course of antibiotics. This case highlights the value of early recognition of this rare but potentially life-threatening condition, considerations around anticoagulation and antibiotic decisions, and the importance of close multidisciplinary follow-up even after discharge from hospital.
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Affiliation(s)
- Alice Liu
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jemma Taylor
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Monica Slavin
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Infectious Diseases & Infection Prevention Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Steven Tong
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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31
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Ouyang JX, Kim EE, Manaloor JJ. Abnormal Eye Movement in a 5-year-old Girl. Pediatr Rev 2021; 42:389-392. [PMID: 34210759 DOI: 10.1542/pir.2020-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - John J Manaloor
- Riley Hospital for Children, Indianapolis, IN.,Ryan White Center for Pediatric Infectious Diseases and Global Health, Indianapolis, IN
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Lee SE, Mushtaq A, Gitman M, Paniz-Mondolfi A, Chung M, Obla A, Sordillo EM, Nowak MD, van Bakel H, Ramírez JD, Muñoz M, Lee M. Lemierre's syndrome associated with hypervirulent Klebsiella pneumoniae: A case report and genomic characterization of the isolate. IDCases 2021; 25:e01173. [PMID: 34141583 PMCID: PMC8188389 DOI: 10.1016/j.idcr.2021.e01173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/24/2022] Open
Abstract
We describe a case of Lemierre’s syndrome (LS) caused by a hypervirulent strain of Klebsiella pneumoniae in a 63-year-old female with hypertension, hyperlipidemia, and diabetes mellitus, who presented with right neck pain and fevers. Computerized tomography of the neck and chest revealed an occluded right internal jugular vein secondary to thrombosis and septic emboli in lungs. Blood cultures grew K. pneumoniae. The patient was treated with ampicillin-sulbactam and then transitioned to amoxicillin-clavulanate to complete a 6-week course of antibiotics, and a 3-month course of rivaroxaban. String test of the K. pneumoniae isolate was positive at 2 cm. Whole genome sequencing identified several genes associated with the hypervirulent strain, notably the genes encoding for aerobactin (iucA and iucB) and salmochelin (iroB) iron acquisition systems. LS can rarely be caused by K. pneumoniae. Clinicians should monitor for known complications, such as septic emboli in patients with LS.
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Affiliation(s)
- Seung Eun Lee
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ammara Mushtaq
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Melissa Gitman
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alberto Paniz-Mondolfi
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marilyn Chung
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ajay Obla
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emilia M Sordillo
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael D Nowak
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Harm van Bakel
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juan David Ramírez
- Centro de Investigaciones en Microbiología y Biotecnología -UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Marina Muñoz
- Centro de Investigaciones en Microbiología y Biotecnología -UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Mikyung Lee
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
Lemierre's syndrome is a rare and potentially life-threatening condition that follows an oropharyngeal infection, typically from Fusobacterium necrophorum, and usually affects healthy adolescents or young adults. The characteristic features are septic thrombophlebitis of the internal jugular vein and septic embolism leading to multiorgan involvement, commonly the brain, lungs and bones. We report a man with presenting symptoms suggesting hemicrania continua, whose initial imaging showed no features of dural venous sinus or jugular thrombosis. Two weeks later, he had fever, sore throat, cervical lymphadenopathy and Actinomyces meyeri grew from peripheral blood cultures. Further imaging identified thrombosis of the internal jugular vein and cerebral venous sinuses, with multifocal cavitating lung lesions. Following antibiotics and anticoagulation, he recovered without residual deficits. Lemierre's syndrome when recognised and treated early has a good prognosis but delayed treatment may result in significant morbidity or mortality.
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Affiliation(s)
- Eng Chuan Foo
- Department of Neurology, Leeds Centre for Neurosciences, Leeds General Infirmary, Leeds, West Yorkshire, UK
| | - Matthew Tanti
- Department of Neurology, Leeds Centre for Neurosciences, Leeds General Infirmary, Leeds, West Yorkshire, UK
| | - Helen Cliffe
- Department of Radiology, Leeds General Infirmary, Leeds, West Yorkshire, UK
| | - Marc Randall
- Department of Neurology, Leeds Centre for Neurosciences, Leeds General Infirmary, Leeds, West Yorkshire, UK
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Abstract
Lemierre’s syndrome is a condition in which an oropharyngeal infection progresses to sepsis and thrombophlebitis of the internal jugular vein. Although the incidence of this syndrome has fallen dramatically since the widespread use of antibiotic therapy to treat streptococcal pharyngitis, it should still be suspected in otherwise healthy young patients presenting with the triad of prolonged pharyngitis, lateral neck pain, and septic symptoms. In this report, we explore a unique case of Lemierre’s syndrome complicated by hypercoagulability and ineffective initial antibiotic therapy.
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Affiliation(s)
- Hannah Doan
- Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Sara Niyazi
- Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - April Burton
- Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Ikramamul Nibir
- Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
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Sukkul P, Kasemsap N. Lemierre's syndrome with cavernous sinus thrombosis caused by dental infection. BMJ Case Rep 2021; 14:14/3/e238521. [PMID: 33727287 PMCID: PMC7970202 DOI: 10.1136/bcr-2020-238521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lemierre's syndrome is a rare multisystemic infection beginning in oropharynx commonly caused by oral anaerobic organisms and leading to internal jugular vein thrombosis with septic emboli. Here, we describe a 45-year-old woman with hypertension and unrecognised type 2 diabetes who presented to a community hospital with fever, double vision and septic shock. Examination showed neck pain aggravated by neck flexion, limited ocular movement of right lateral rectus, left medial rectus and left superior oblique and incomplete ptosis of the left eye. These symptoms were suggestive of bilateral cavernous sinus syndrome. CT of the brain showed bilateral proximal internal jugular vein and cavernous sinus thrombosis. CT angiography revealed septic emboli at both upper lungs. The patient had good improvement of neurological symptoms after dental extraction, intravenous antibiotic and anticoagulant.
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Affiliation(s)
- Peerawat Sukkul
- Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Narongrit Kasemsap
- Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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36
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Oermann CM. A 16-year-old with Lemierre's syndrome and multiple septic pulmonary emboli. Pediatr Pulmonol 2021; 56:347-348. [PMID: 33270999 DOI: 10.1002/ppul.25183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/16/2020] [Accepted: 11/16/2020] [Indexed: 11/07/2022]
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Lemierre Syndrome: Unusual Presentation With Superior Ophthalmic Vein Thrombosis. J Craniofac Surg 2021; 32:1079-1082. [PMID: 33405462 DOI: 10.1097/scs.0000000000007363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
ABSTRACT Lemierre syndrome (LS) is a rare, but serious condition most commonly associated with oropharyngeal bacterial infection. Infection results in thrombophlebitis of the internal jugular vein and its tributaries. It usually affects previously healthy young adults. The authors report an unusual case of an elderly patient with penicillin allergy who developed Lemierre syndrome from an odontogenic infection (Streptococcus intermedius) resistant to clindamycin. She developed thrombosis of the internal jugular vein and superior ophthalmic vein resulting in visual changes. Treatment required incision and drainage, intravenous antibiotics and anticoagulation. Antibiotics were tailored to culture and sensitivities after testing response to a beta-lactam. With antibiotic resistance increasing, investigation of penicillin allergies is warranted for severe head and neck infections.
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Gusnowski EM, Morrison LJ, Bois AJ. Infectious Brachial Plexopathy and Septic Arthritis of the Shoulder due to Lemierre's Syndrome: A Case Report and Literature Review. JBJS Case Connect 2020; 10:e20.00362. [PMID: 33439602 DOI: 10.2106/jbjs.cc.20.00362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We present a 20-year-old female with Lemierre's syndrome and an associated infectious brachial plexopathy and missed septic shoulder arthritis. She subsequently presented with advanced post-infectious glenohumeral joint arthritis. At the final 12-month follow-up, substantial shoulder pain and dysfunction persisted. CONCLUSIONS When Lemierre's syndrome has been diagnosed, patients with upper extremity symptoms suggestive of metastatic infection require a thorough assessment to rule out musculoskeletal involvement and site-specific intervention to prevent long-term morbidity.
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Affiliation(s)
- Eva M Gusnowski
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta Canada
| | - Laura J Morrison
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta Canada
| | - Aaron J Bois
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Karn MN, Johnson NP, Yaeger SK, Fugok KL. A teenager with fever, chest pain, and respiratory distress during the coronavirus disease 2019 pandemic: a lesson on anchoring bias. J Am Coll Emerg Physicians Open 2020; 1:1392-1394. [PMID: 33043318 PMCID: PMC7537251 DOI: 10.1002/emp2.12261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/25/2020] [Accepted: 08/03/2020] [Indexed: 11/21/2022] Open
Abstract
Symptoms of coronavirus disease 2019 overlap with other important illnesses affecting young adults. We report a case of a 17-year old male presenting to the emergency department in the midst of a pandemic with symptoms of coronavirus disease 2019. He had fever, dyspnea, chest pain, and myalgias, with bilateral infiltrates on chest radiograph, and developed septic shock secondary to infectious thromboembolic events. However, his blood cultures grew group G streptococcus secondary to his oropharyngeal infection, and he experienced an infectious thrombus in the internal jugular vein, consistent with the rare but well-described Lemierre's syndrome. This case report calls attention to the importance of maintaining differential diagnoses and thereby minimizing the biases and assumptions that come with clinical care during a pandemic.
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Affiliation(s)
- Michele N. Karn
- Department of Emergency and Hospital Medicine/University of South Florida, Morsani College of MedicineLehigh Valley Health NetworkAllentownPennsylvaniaUSA
| | - Nicholas P. Johnson
- Department of Emergency and Hospital Medicine/University of South Florida, Morsani College of MedicineLehigh Valley Health NetworkAllentownPennsylvaniaUSA
| | - Susan K. Yaeger
- Lehigh Valley Health Network, Department of Emergency and Hospital MedicineDivision of Pediatric Emergency Medicine/University of South Florida, Morsani College of MedicineAllentownPennsylvaniaUSA
| | - Kimberly L. Fugok
- Lehigh Valley Health Network, Department of Emergency and Hospital MedicineDivision of Pediatric Emergency Medicine/University of South Florida, Morsani College of MedicineAllentownPennsylvaniaUSA
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Gama R, Sousa M, Castro F, Condé A. Lemierre's syndrome: a forgotten life-threatening entity. BMJ Case Rep 2020; 13:13/10/e236201. [PMID: 33127694 DOI: 10.1136/bcr-2020-236201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lemierre's syndrome is a very rare but potentially fatal condition. It mainly affects adolescents and young adult males, and usually arises as a serious complication of pharyngitis or peritonsillar abscess. It is characterised by the triad of internal jugular vein septic thrombophlebitis, septic emboli (mostly pulmonary) and the isolation of the agent 'Fusobacterium necrophorum' in sterile fluids. In this report, it is described a case in which the nonspecific and subtle clinic made the diagnosis difficult to reach. In fact, only the dissociation between flu-like symptoms and the presence of significant changes in the blood tests (suggestive of acute bacterial infection), led to the request for imaging tests, which proved to be essential for the final diagnosis and subsequent control of the disease. This case report aims to increase the awareness among Ear, Nose and Throat (ENT) residents, paediatricians and family doctors about the existence of this entity and its potential life-threatening nature.
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Affiliation(s)
- Rita Gama
- Otorhinolaryngology and Head and Neck Surgery Department, Centro Hospitalar de Vila Nova de Gaia, Porto, Porto, Portugal
| | - Manuel Sousa
- Otorhinolaryngology and Head and Neck Surgery Department, Centro Hospitalar de Vila Nova de Gaia, Porto, Porto, Portugal
| | - Fernanda Castro
- Otorhinolaryngology and Head and Neck Surgery Department, Centro Hospitalar de Vila Nova de Gaia, Porto, Porto, Portugal
| | - Artur Condé
- Otorhinolaryngology and Head and Neck Surgery Department, Centro Hospitalar de Vila Nova de Gaia, Porto, Porto, Portugal
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41
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Howley F, O'Doherty L, McEniff N, O'Riordan R. Late presentation of 'Lemierre's syndrome': how a delay in seeking healthcare and reduced access to routine services resulted in widely disseminated Fusobacterium necrophorum infection during the global COVID-19 pandemic. BMJ Case Rep 2020; 13:13/10/e239269. [PMID: 33040042 PMCID: PMC7549461 DOI: 10.1136/bcr-2020-239269] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The SARS-CoV-2 outbreak has disrupted the delivery of routine healthcare services on a global scale. With many regions suspending the provision of non-essential healthcare services, there is a risk that patients with common treatable illnesses do not receive prompt treatment, leading to more serious and complex presentations at a later date. Lemierre’s syndrome is a potentially life-threatening and under-recognised sequela of an oropharyngeal or dental infection. It is characterised by septic embolisation of the gram-negative bacillus Fusobacterium necrophorum to a variety of different organs, most commonly to the lungs. Thrombophlebitis of the internal jugular vein is frequently identified. We describe an atypical case of Lemierre’s syndrome involving the brain, liver and lungs following a dental infection in a young male who delayed seeking dental or medical attention due to a lack of routine services and concerns about the SARS-CoV-2 outbreak.
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Affiliation(s)
- Fergal Howley
- Department of General Internal Medicine, St James's Hospital, Dublin, Ireland
| | - Laura O'Doherty
- Department of General Internal Medicine, St James's Hospital, Dublin, Ireland
| | - Niall McEniff
- Department of Radiology, St James's Hospital, Dublin, Ireland
| | - Ruth O'Riordan
- Department of General Internal Medicine, St James's Hospital, Dublin, Ireland
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Patel PN, Levi JR, Cohen MB. Lemierre's syndrome in the pediatric population: Trends in disease presentation and management in literature. Int J Pediatr Otorhinolaryngol 2020; 136:110213. [PMID: 32797805 DOI: 10.1016/j.ijporl.2020.110213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aims to examine literature on Lemierre's Syndrome (LS) in the pediatric population over time in order to describe patterns in disease progression, management, and prognosis. In addition, this study assesses specific rate of literature output and the location of research over the past 10 years. METHODS A literature review was conducted through two databases, PubMed.gov and PMC. A search was conducted using the keywords "Lemierre syndrome" and "postanginal sepsis." Literature was primarily reviewed for demographic, radiographic, and clinical data. Articles were included in the study if they were published in English and within the last 10 years. All types of research studies were recorded, however primary data collection came from case reports and series. Publications were grouped into two time periods: 2009-2013 and 2014-2019, allowing for comparison of various characteristics between these two groups. RESULTS A total of 124 research studies on LS met inclusion criteria and were reviewed. Of these, 98 case reports (79.0%) were examined. Disease Characteristics: Fusobacterium necrophorum was the most common precipitating pathogen isolated from cultures (66.2%). The main primary treatment modalities used were antimicrobials, surgery, anticoagulation, or a combination of these treatments. A total of 63.9% of the case reports indicated use of anticoagulation at some point during treatment. Publication Trends: The number of published studies has not significantly changed in the last decade, with a non-statistically significant decline of 5.6%, when comparing 2014-2019 to 2009-2013 (p = 0.21). Case reports/series were the most common study design (82.2% vs 69.5%) and level of evidence for published studies continued to be stable (level 4-5) through the years (86.9%). The number of publications within an international journal vs US based journal has also remained steady during both time periods (p = 0.698). CONCLUSION LS is an uncommon condition but one that is important for physicians to be aware of in the pediatric population. Treatment regimens including antibiotics and anticoagulation have remained stable through the past 10 years, however the efficacy of anticoagulation in treating LS continues to be debated. Though LS is considered a severe illness with potentially life threatening complications, publications on this topic, in pediatrics specifically, have decreased within the past five years.
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Affiliation(s)
- Prachi N Patel
- Boston Medical Center, Department of Otolaryngology - Head and Neck Surgery, Boston, USA.
| | - Jessica R Levi
- Boston Medical Center, Department of Otolaryngology - Head and Neck Surgery, Boston, USA.
| | - Michael B Cohen
- Boston Medical Center, Department of Otolaryngology - Head and Neck Surgery, Boston, USA.
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Dasari SP, Jha P. A Systematic Review of Lemierre's Syndrome With a Focus on Ophthalmologic Complications. Cureus 2020; 12:e9326. [PMID: 32742884 PMCID: PMC7384458 DOI: 10.7759/cureus.9326] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Lemierre's syndrome (LS), once known as "the forgotten disease," is a rare and potentially life-threatening condition that has had a gain in incidence over the last 30 years due to a variety of factors that could include changes in antibody prescription patterns, particularly in regard to the treatment of pharyngitis/tonsillitis. Due to its low incidence and broad spectrum of symptoms, LS does not have an obvious clinical diagnosis and can confuse the clinician managing the patient. Furthermore, it is equally difficult to treat patients suffering from LS as it requires a multidisciplinary approach from multiple subspecialties. Thus, communication between hospitalists, radiologists, otolaryngologists, neurologists, and ophthalmologists is critical towards quickly diagnosing the disease condition so that prompt antibiotics, anticoagulation, and surgical intervention can occur. Atypical presentations can also exist, making the diagnosis and management exponentially more challenging. Ophthalmologic symptoms are a particularly rare and atypical presentation of LS. These rare symptoms in LS can be terrifying for patients and providers alike; yet, there does not seem to be any modern medical literature that summarizes ophthalmologic complications for LS patients. To our knowledge, this is the first systematic review of LS with a focus on ophthalmologic complications that has been done. The main objective of this review paper is to provide an up-to-date literature review of LS epidemiology, pathophysiology, diagnosis, and treatment while also performing a novel systematic review of reported cases of LS with ophthalmological complications. We hope to bring more awareness towards LS and its atypical presentations so that physicians will be better able to rapidly diagnose and treat their patients in order to minimize long-term morbidity and mortality.
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Affiliation(s)
- Suhas P Dasari
- Internal Medicine, Medical College of Wisconsin, Wauwatosa, USA
| | - Pinky Jha
- Internal Medicine, Medical College of Wisconsin, Wauwatosa, USA
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Fernandez D, Ahmad M, Decker G, Aloysius MM. Lemierre's syndrome in an intravenous drug user. BMJ Case Rep 2020; 13:e235390. [PMID: 32624490 PMCID: PMC7341724 DOI: 10.1136/bcr-2020-235390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2020] [Indexed: 11/03/2022] Open
Abstract
A 29-year-old Dominican man with a history of intravenous heroin use and hepatitis C presented with a 5-day history of fever, dyspnoea, haemoptysis, pleuritic chest pain, abdominal pain, haematochezia and haematemesis. Initial physical examination was significant for scleral icterus, generalised abdominal tenderness to palpation, melaena and blood-tinged sputum. Blood cultures grew Fusobacterium species. CT scan of the chest revealed multiple bilateral cavitary features in lung fields. At the same time, a neck ultrasound performed demonstrated thrombophlebitis in the right internal jugular vein, confirming the diagnosis of 'Lemierre's syndrome'. Treatment was with antibiotics and supportive care for 6 weeks.
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Affiliation(s)
- Daniel Fernandez
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
| | - Mirza Ahmad
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
| | - Gary Decker
- Department of Infectious Disease, Wilkes-Barre General Hospital, Wilkes-Barre, Pennsylvania, USA
| | - Mark M Aloysius
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
- Department of Internal Medicine, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
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45
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[Cervicofacial cellulitis complicated by internal jugular vein thrombosis]. Ann Dermatol Venereol 2020; 147:643-647. [PMID: 32505376 DOI: 10.1016/j.annder.2020.04.013] [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: 11/18/2019] [Revised: 02/03/2020] [Accepted: 04/24/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Cervicofacial cellulitis (CFC) is one of the most common dermatological infectious emergencies, and related morbidity and mortality are non-negligible. PATIENTS AND METHODS We describe the case of a 31-year-old male with left parotitis complicated by CFC with worsening over the previous week despite treatment with clindamycin and non-steroidal anti-inflammatory drugs. A cervicofacial computed tomography (CT) scan showed left internal jugular vein thrombosis (IJVT). Chest imaging showed no pleuropulmonary lesion, and bacteriological samples were negative. The patient received broad-spectrum antibiotic therapy and anticoagulants for 6 weeks. The outcome was quickly favourable. DISCUSSION It is essential to perform a cervicofacial contrast-enhanced CT scan for any CFC to map the affected areas, detect the primary infection and screen for loco-regional complications such as IVJT. The occurrence of IJVT in an infectious setting should prompt screening for septic emboli, especially pulmonary emboli, as well as performance of a chest CT scan. The presence of septic emboli associated with a recent ENT infection and of IJVT or Fusobacteriumnecrophorum in blood cultures are indicative of Lemierre's syndrome. CONCLUSION IJVT is an uncommon complication of CFC that occurs either alone or as part of Lemierre's syndrome.
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Hameed T, Bawazeer M, Alfattoh N, Alanazi S. A 4-year-old boy with Lemierre's syndrome caused by methicillin-sensitive Staphylococcus aureus. J Infect Public Health 2020; 13:1360-1362. [PMID: 32507402 DOI: 10.1016/j.jiph.2020.05.013] [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: 03/30/2020] [Revised: 05/12/2020] [Accepted: 05/17/2020] [Indexed: 11/30/2022] Open
Abstract
A pre-school aged boy presented to the Pediatric Emergency Department with a high grade fever and neck pain and stiffness. Blood culture was positive for methicillin-sensitive Staphylococcus aureus (MSSA) and Doppler ultrasound of the neck revealed partial thrombosis of the left internal jugular vein. He was diagnosed with Lemierre's syndrome (LS) and treated with a prolonged course of antibiotics and anticoagulation. After discharge home, he was followed in the outpatient clinics and had a full recovery. This case report will highlight the presentation of LS and will briefly review the microbiology of this condition.
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Affiliation(s)
- Tahir Hameed
- Department of Pediatrics, King Abdullah Specialized Children's Hospital, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Manal Bawazeer
- Department of Pediatrics, King Abdullah Specialized Children's Hospital, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Nora Alfattoh
- Department of Pediatrics, King Abdullah Specialized Children's Hospital, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sami Alanazi
- Department of Pediatrics, King Abdullah Specialized Children's Hospital, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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B K A, Gilotra T, Tymko C, Siddique Z, Eranki A. A Rare Case of Lemierre's Syndrome Caused by Streptococcus Intermedius, Presenting as an Epidural Abscess. Cureus 2020; 12:e7787. [PMID: 32455086 PMCID: PMC7243612 DOI: 10.7759/cureus.7787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Lemierre's syndrome is a rare but life-threatening condition characterized by an oropharyngeal infection typically secondary to Fusobacterium necrophorum resulting in septic thrombophlebitis of the internal jugular vein. Streptococcus intermedius is a particularly rare cause of Lemierre's syndrome with only a few cases reported in the literature. Here we describe a rare case of Lemierre's syndrome, caused by Streptococcus intermedius, likely secondary to an odontogenic infection, found to have a cervical epidural abscess with concomitant large retropharyngeal and prevertebral abscesses on presentation, in whom the clinical course was further complicated by an extensive cerebral venous sinus thrombosis. However, despite grave complications, early diagnosis and appropriate emergency management including intravenous antibiotics and surgical intervention led to a successful recovery, thus demonstrating that aggressive measures can potentially lead to a favorable outcome.
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Affiliation(s)
- Anupama B K
- Internal Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
| | - Tarvinder Gilotra
- Infectious Disease, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
| | - Casey Tymko
- Anesthesiology, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
| | - Zaid Siddique
- Radiology, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
| | - Ambika Eranki
- Infectious Disease, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
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The Forgotten Disease: A Case of Lemierre’s Syndrome with Distal Extremity Involvement. Case Rep Infect Dis 2020; 2020:4346937. [PMID: 32257468 PMCID: PMC7102455 DOI: 10.1155/2020/4346937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/09/2020] [Accepted: 02/25/2020] [Indexed: 11/25/2022] Open
Abstract
Once coined the “Forgotten Disease,” Lemierre's syndrome is a rare condition that results from oropharyngeal infection with the gram-negative, anaerobic Fusobacterium necrophorum. The typical progression of illness involves spread to adjacent structures such as the internal jugular vein with resulting thrombophlebitis. Septic emboli to distant sites are also a common sequela. Here, we present a case of Lemierre's syndrome in a 20-year-old, otherwise healthy, male. The patient presented with fever, sore throat, and dysphagia. Imaging revealed peritonsillar multiloculated fluid collections and necrotizing pneumonia with multiple pulmonary abscesses. The patient's hospital course was complicated by the development of necrotizing fasciitis in his right lower leg, which required incision and drainage with surgical washout. In addition to systemic intravenous antibiotics and anticoagulation, he underwent multiple thoracentesis procedures. The patient was ultimately transferred to a tertiary care center due to persistent fevers and lung abscesses. This case highlights the challenges of initial diagnosis, as well as the treatment choices faced by the attending physicians.
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Siddique MK, Chang G, Lagmay V, Shih M. Lemierre's syndrome caused by Streptococcus pyogenes in an elderly woman. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:31-33. [PMID: 32055760 PMCID: PMC7005475 DOI: 10.1016/j.jvscit.2019.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 11/12/2019] [Indexed: 12/12/2022]
Abstract
Lemierre's syndrome is characterized by septic thrombophlebitis of the internal jugular vein. It typically presents in healthy adolescents or young adults, usually preceded by an oropharyngeal infection, with the most common offending pathogen being Fusobacterium necrophorum. We present a case of Lemierre's syndrome in an elderly woman without antecedent oropharyngeal infection, caused by Streptococcus pyogenes. She was successfully treated with combined surgical and medical management.
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Affiliation(s)
| | - Grace Chang
- AT Still University School of Osteopathic Medicine, Mesa, Ariz
| | - Victor Lagmay
- Division of Otolaryngology, Maimonides Medical Center, Brooklyn, NY
| | - Michael Shih
- Division of Vascular and Endovascular Surgery, Maimonides Medical Center, Brooklyn, NY
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Wu MY, Hou YT, Ke JY, Yiang GT. Case of internal jugular vein thrombosis and fever: Lemierre's syndrome or Trousseau's syndrome? Tzu Chi Med J 2020; 32:91-95. [PMID: 32110528 PMCID: PMC7015004 DOI: 10.4103/tcmj.tcmj_34_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/12/2019] [Accepted: 02/01/2019] [Indexed: 12/21/2022] Open
Abstract
Internal jugular vein thrombosis is a rare critical cardiovascular emergency, which has potential catastrophic clinical outcomes by resulting in stroke and pulmonary embolism. Several etiologies have been reported; however, there are limited data on Lemierre's and Trousseau's syndromes, which are both rare conditions with advanced disease progression and poor clinical outcomes. Lemierre's syndrome may present with typical progressively infectious symptoms and signs, including sore throat, neck mass, and fever, whereas Trousseau's syndrome may present with thrombophlebitis and painful edema. Without antibiotic agents controlling the infection, the condition of patients with Lemierre's syndrome may progress to sepsis or septic shock. The infection pattern plays an important role for differential diagnosis. Herein, we describe the case of a 46-year-old woman presenting with atypical symptoms of Trousseau's syndrome mimicking Lemierre's syndrome. Laboratory analysis including protein C, protein S, rheumatoid factor, and antinuclear antibody ruled out hypercoagulopathy and autoimmune vasculitis. Abdominal computed tomography and panendoscopy revealed ulcerative tumor at the antrum. Pathological examination confirmed the presence of signet-ring cell adenocarcinoma. We highlight the clinical features and etiologies of internal jugular vein thrombosis, especially in Lemierre's syndrome and Trousseau's syndrome, to aid physicians in making an early diagnosis and providing timely management.
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Affiliation(s)
- Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yueh-Tseng Hou
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jian-Yu Ke
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Giou-Teng Yiang
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
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