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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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Dai YL, Chen VM, Hedges TR, Malek A. Lemierre syndrome associated mycotic cavernous sinus thrombosis and carotid aneurysm after COVID-19. Am J Ophthalmol Case Rep 2022; 27:101642. [PMID: 35782172 PMCID: PMC9238024 DOI: 10.1016/j.ajoc.2022.101642] [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: 04/14/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose The purpose of this article is to report a case of Lemierre syndrome associated mycotic aneurysm of the intracavernous carotid artery leading to cavernous sinus syndrome in an otherwise healthy, young man in the setting of COVID-19 infection. Observations An 18-year-old, otherwise healthy male athlete developed fever, chills, and headache and was found to be positive for COVID-19 with gram negative bacteremia. While on systemic antibiotic treatment, he developed acute, left-sided, 6th nerve palsy and was found to have bacterial sinusitis, left-sided intracavernous mycotic aneurysm, and cavernous sinus thrombosis on imaging studies. Despite systemic antibiotic and antiplatelet therapy, he developed progressively worsening left-sided ophthalmoplegia and vision decline. He subsequently underwent left internal carotid artery embolization and cervical internal carotid artery sacrifice with excellent outcome. Conclusion and importance Lemierre syndrome can have atypical presentations and complications, including cavernous sinus thrombosis and mycotic aneurysms. Recognition of signs and symptoms, including progressive multiple cranial neuropathies, can aid in early diagnosis and management, which requires multidisciplinary care tailored to each individual based on risk of intervention.
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Affiliation(s)
- Yi Ling Dai
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, USA
- Corresponding author. New England Eye Center/Tufts Medical Center, Department of Ophthalmology, 800 Washington Street, Boston, MA, 02116, USA.
| | - Vicki M. Chen
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, USA
| | - Thomas R. Hedges
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, USA
- Department of Neurology, Tufts Medical Center, Boston, USA
| | - Adel Malek
- Department of Neurosurgery, Tufts Medical Center, Boston, USA
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Suzuki R, Terayama M, Tanda M, Takahashi G. Lemierre's syndrome with isolated external jugular vein thrombosis caused by Streptococcus intermedius. IDCases 2022; 28:e01495. [PMID: 35402160 PMCID: PMC8991105 DOI: 10.1016/j.idcr.2022.e01495] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/01/2022] [Indexed: 11/18/2022] Open
Abstract
An 85-year-old woman with a history of rheumatoid arthritis fell due to unsteadiness and visited our emergency room due to head injury. The patient had minor head trauma and lip and oral cavity injuries, and she presented with fever. Laboratory tests showed high inflammatory marker levels. Moreover, there were indicative of urinary tract infection. Thus, the patient was admitted to our hospital. Blood cultures performed upon admission revealed the presence of Streptococcus intermedius, and contrast-enhanced computed tomography scan showed solitary right external jugular vein thrombosis and multiple abscesses in both lungs. Hence, the patient was diagnosed with Lemierre’s syndrome, and antimicrobial agents and anticoagulants were administered. The patient developed left pleurisy due to inflammation caused by lung abscesses, which improved with thoracic drainage. Her condition improved satisfactorily, and she was then discharged. There are only few studies about Lemierre’s syndrome caused by S. intermedius and even lesser cases involving external jugular vein thrombosis. Herein, we report a relatively rare case of Lemierre’s syndrome with isolated external jugular vein thrombosis.
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Affiliation(s)
- Rioto Suzuki
- Correspondence to: Advanced Critical Care and Emergency Center, Iwate Medical University Hospital, 2-1-1, Idaidori, Yahaba-cho, Shiwa-gun, Iwate Prefecture, 028–3695, Japan.
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An unusual case of Lemierre syndrome - One pathogen or two? IDCases 2021; 25:e01203. [PMID: 34221895 PMCID: PMC8243003 DOI: 10.1016/j.idcr.2021.e01203] [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: 04/27/2021] [Revised: 06/20/2021] [Accepted: 06/20/2021] [Indexed: 11/25/2022] Open
Abstract
Lemierre Syndrome is characterized by thrombophlebitis of the internal jugular vein. The disease is rare, typically preceded by pharyngitis, and is caused usually by Fusobacterium necrophorum. In rare cases, Lemierre Syndrome is polymicrobial involving other oral microbes.
Lemierre syndrome, or septic thrombophlebitis of the internal jugular vein, is a rare disease that affects healthy young adults following an episode of pharyngitis or other upper respiratory disease. It most commonly involves the anaerobe Fusobacterium necrophorum, a component of normal oral flora. In this report, we present an unusual case of polymicrobial Lemierre syndrome involving both F. necrophorum and Group C streptococcus following an episode of pharyngitis and streptococcal toxic shock syndrome. Providers should consider the possibility of polymicrobial infection when there are imaging findings suggestive of Lemierre Syndrome and adjust antibiotic regimens accordingly.
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Kawai H, Shiojiri T. Internal jugular vein thrombosis associated with Granulicatella adiacens. BMJ Case Rep 2021; 14:e238404. [PMID: 33472803 PMCID: PMC10577762 DOI: 10.1136/bcr-2020-238404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 11/19/2022] Open
Abstract
Granulicatella adiacens, which occurs as part of the oral microflora, is an uncommon cause of infection. However, it can cause serious bloodstream infections including infective endocarditis. Although oral bacteria, most commonly the Fusobacterium spp, can cause internal jugular vein (IJV) thrombophlebitis, there are no reported cases of IJV thrombosis caused by G. adiacens Here we report a patient with septic IJV thrombosis with G. adiacens bacteraemia. A middle-aged man presented to our hospital with fever and altered mental status. Blood cultures were positive for G. adiacens, and pan-scan CT with contrast showed left IJV thrombosis, pulmonary embolism and abscesses in the gluteal muscles. The patient was successfully treated with antibiotics. When confronted with G. adiacens bacteraemia in patients with poor oral hygiene, it is necessary to be cautious of the fact that this organism can cause IJV thrombophlebitis.
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Affiliation(s)
- Honami Kawai
- Department of General Internal Medicine, Kokuho Asahi Chuo Hospital, Asahi, Chiba, Japan
| | - Toshiaki Shiojiri
- Department of General Internal Medicine, Kokuho Asahi Chuo Hospital, Asahi, Chiba, Japan
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Adedeji A, Chukwura O, Obafemi T, McNulty SB, Reinert JP. Anticoagulation Strategies in the Management of Lemierre Syndrome: A Systematic Review of the Literature. Ann Pharmacother 2020; 55:658-665. [PMID: 32909436 DOI: 10.1177/1060028020957620] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To determine the optimal anticoagulation strategy in patients diagnosed with Lemierre Syndrome (LS). DATA SOURCES A systematic review in accordance with PRISMA guidelines was conducted using PubMed, MEDLINE, Scopus, ProQuest, and CINAHL from January to April 2020. Search terms included "Lemierre Syndrome" AND "anticoagulation" NOT "prophylaxis" OR "atrial fibrillation," in addition to a list of parenteral and oral anticoagulants. Adult patients who developed a clot and required systemic anticoagulation as a result of LS were included in this review. STUDY SELECTION AND DATA EXTRACTION A total of 4180 records were initially identified, though following the removal of duplicates and nonrelevant entries, 216 full-text articles were reviewed for inclusion; 13 articles were ultimately included. DATA SYNTHESIS The majority (11/14) of patients developed thromboses of the internal jugular veins, which corresponds to the pathophysiology of LS. Anticoagulation strategies were varied in the included literature, though 12/14 patients initially received a parenteral product. Two patients received a direct-acting oral anticoagulant (DOAC) following either intravenous heparin or subcutaneous enoxaparin and had outcomes similar to patients transitioned to warfarin. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Anticoagulation in LS is a clinical controversy because the thromboembolic events have rarely led to significant complications; thrombi typically resolve independently, and concerns for bleeding risks are well founded; however, this review indicates both the efficacy and safety of anticoagulation. CONCLUSIONS Anticoagulation is both efficacious and safe in LS, including treatment using a DOAC. Although further studies are needed, clinicians should consider a duration of anticoagulation of 6 to 12 weeks.
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B K A, Gilotra T, Tymko C, Siddique Z, Eranki A. A Rare Case of Lemierre's Syndrome Caused by Streptococcus Intermedius, Presenting as an Epidural Abscess. Cureus 2020; 12:e7787. [PMID: 32455086 PMCID: PMC7243612 DOI: 10.7759/cureus.7787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Lemierre's syndrome is a rare but life-threatening condition characterized by an oropharyngeal infection typically secondary to Fusobacterium necrophorum resulting in septic thrombophlebitis of the internal jugular vein. Streptococcus intermedius is a particularly rare cause of Lemierre's syndrome with only a few cases reported in the literature. Here we describe a rare case of Lemierre's syndrome, caused by Streptococcus intermedius, likely secondary to an odontogenic infection, found to have a cervical epidural abscess with concomitant large retropharyngeal and prevertebral abscesses on presentation, in whom the clinical course was further complicated by an extensive cerebral venous sinus thrombosis. However, despite grave complications, early diagnosis and appropriate emergency management including intravenous antibiotics and surgical intervention led to a successful recovery, thus demonstrating that aggressive measures can potentially lead to a favorable outcome.
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Affiliation(s)
- Anupama B K
- Internal Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
| | - Tarvinder Gilotra
- Infectious Disease, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
| | - Casey Tymko
- Anesthesiology, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
| | - Zaid Siddique
- Radiology, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
| | - Ambika Eranki
- Infectious Disease, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
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Deep neck space infection and Lemierre's syndrome caused by Streptococcus anginosus: A case report. IDCases 2020; 19:e00669. [PMID: 32226760 PMCID: PMC7093741 DOI: 10.1016/j.idcr.2019.e00669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction Deep neck space infections most commonly arise from a septic focus of the mandibular teeth, tonsils, parotid gland, middle ear or sinuses, usually with a rapid onset and frequently with progression to life-threatening complications. Lemierre’s syndrome is classically defined by an oropharyngeal infection with internal jugular vein thrombosis followed by metastatic infections in other organs. Case presentation A 32-year-old female patient, with no significant past medical history, was diagnosed with a dental abscess on her left inferior 3rd molar. Six days later, the condition complicated with severe upper respiratory distress, odynophagia and trismus, and extension of the inflammatory signs to the anterior cervical region, involving the upper airway. Computed tomography scan confirmed extension to submandibular, parapharyngeal and retrosternal spaces), which required nasotracheal intubation due to compromised airway. Urgent and subsequent surgical drainages were performed, alongside with concomitant antibiotic therapy. Additionally, left internal jugular vein thrombosis was described - with later extension to the brachiocephalic vein, without other complications, consistent with Lemierre's syndrome, although without full features. Streptococcus anginosus was identified in the drained pus specimens. The patient made a satisfactory clinical progress and was discharged after 25 days, still under therapeutic hypocoagulation. Conclusion As deep neck space infections can be life-threatening, clinicians must be aware and not underestimate their potential severity. Lemierre's syndrome is a complication difficult to recognize, which requires additional awareness of the many possible presentations, for appropriate diagnostic studies and therapeutic plan.
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Abstract
INTRODUCTION Pilomatrixoma, also known as calcifying epithelioma of Malherbe, is a superficial benign skin tumor that arises from hair follicle matrix cells. Although pilomatrixomas are well-recognized lesions, clinically they are frequently misdiagnosed as other skin conditions. By reviewing all the literature over the past 10 years, the aims of this article are to analyze the cause, clinical presentation, management, and outcome of pilomatrixoma among children and adults to gain a more complete understanding of this lesion in today's clinical context. METHODS A MEDLINE and EMBASE search was conducted from January 2005 to February 2015 using a combination of the terms: "child," "childhood," "adult," and keywords: "pilomatrixoma," "pilomatricoma," and "calcifying epithelioma of Malherbe." A total of 150 articles were reviewed. RESULTS The lesions occurred most commonly in the first and second decades (mean age 16 years and 7 months). The commonest presentation was of an asymptomatic, firm, slowly growing, mobile nodule. Only 16% were accurately diagnosed on clinical examination. Imaging in the form of ultrasound, computed tomography, and magnetic resonance imaging has been reported. Pathological diagnosis was achieved through incision, punch, and shave biopsies. Pathological findings are discussed and summarized in this review. CONCLUSION Pilomatrixomas are thought to arise from mutation in the Wnt pathway and has been linked to several genetic conditions. It is commonly misdiagnosed preoperatively; however, with better awareness of the lesion, it can be appropriately treated while avoiding unnecessary diagnostic tests. Complete surgical excision with clear margins is almost always curative.
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A Rare Case of Lemierre-Like Syndrome: A Case Report and Literature Review. Case Rep Pediatr 2018; 2018:9613493. [PMID: 29808152 PMCID: PMC5902060 DOI: 10.1155/2018/9613493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/22/2018] [Accepted: 02/06/2018] [Indexed: 11/21/2022] Open
Abstract
Lemierre's syndrome (LS) is a serious rare complication of oropharyngeal infections. It is characterized by thrombosis of internal jugular vein that rapidly progresses into sepsis and is typically caused by anaerobes. Most of the reported cases have been linked to Fusobacterium necrophorum; however, there are a handful of reported cases due to aerobes. It is primarily the disease of healthy young adults and can present in school-aged children. The early recognition and treatment of this complication results in resolution of the illness; nevertheless, there have been some concerns about chronic venous insufficiency as a long-term complication. We report a case of a 6-year-old boy, who presented with fever and headache with a history of sore throat. His blood culture was positive for group A Streptococcus (GAS) and was subsequently found to have internal jugular vein, sigmoid, and transverse sinus vein thrombosis.
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Abstract
Lemierre's syndrome is a rare and feared complication of pharyngitis, occurring most commonly in adolescents and young adults. It is typically defined by the constellation of septic internal jugular vein thrombophlebitis, pulmonary and other septic emboli, and sterilesite infection by Fusobacterium necrophorum. The rarity and severity of Lemierre's syndrome has made it an attractive subject for case reports but there is a paucity of evidence to inform areas of persistent uncertainty. In recent years, heightened attention and controversy has focused upon speculation that a purported rise in the incidence of Lemierre's syndrome is due to reduced antibiotic prescribing for respiratory tract infections, that F. necrophorum is an under-appreciated cause of acute tonsillopharyngitis and that testing and targeted treatment would prevent cases of Lemierre's syndrome.
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Çıvgın E, Toprak U, Parlak S, Özer H. Fissuration of vertebral artery mycotic aneurysm due to Lemierre syndrome. Diagn Interv Imaging 2018; 99:43-45. [DOI: 10.1016/j.diii.2017.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/21/2017] [Accepted: 06/01/2017] [Indexed: 11/28/2022]
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Abstract
Lemierre's syndrome is rare, with no known reported cases in the Caribbean thus far. We highlight a case of a young woman who presented with diabetic ketoacidosis precipitated by oral pharyngeal sepsis, whose condition rapidly deteriorated within 24 hours requiring ventilation and administration of antibiotics. Her sepsis was accompanied by internal jugular vein thrombosis in keeping with a diagnosis of Lemierre's syndrome, which was treated aggressively with antibiotics, intensive care and mechanical ventilatory support in the intensive care unit. She made a full recovery. Though this is the first reported case in the Caribbean of this ‘forgotten disease’, it must not be forgotten because prognosis and outcome are markedly improved with prompt and aggressive treatment.
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Affiliation(s)
- Mandreker Bahall
- Department of Clinical and Medical Sciences, University of the West Indies., St. Augustine, Trinidad and Tobago
| | - Stanley Giddings
- Department of Clinical and Medical Sciences, University of the West Indies., St. Augustine, Trinidad and Tobago
| | - Krishni Bahall
- Department of Medicine, San Fernando General Hospital, San Fernando., Trinidad and Tobago
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Osman M, Hasan S, Bachuwa G. Oesophageal cancer presenting as Lemierre's syndrome caused by Streptococcus anginosus. BMJ Case Rep 2017; 2017:bcr-2017-219661. [PMID: 28416472 DOI: 10.1136/bcr-2017-219661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 59-year-old man presented to the emergency department with complaints of dysphagia, right-sided neck swelling, fever and chills. Physical examination was remarkable for fever and tender swelling over the right side of the neck. Laboratory investigations revealed leucocytosis with neutrophilia. CT of the neck showed right internal jugular vein thrombosis with an overlying abscess and a nodular opacity in the right lung apex with air locules. He underwent surgical drainage of the neck abscess. Aerobic cultures from the drainage and blood cultures grew Streptococcus anginosus Given his initial complaint of dysphagia, upper endoscopy was performed which showed a mass in the upper oesophagus. Histopathology confirmed squamous cell carcinoma. The patient received 6 weeks of antibiotics therapy.
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Affiliation(s)
| | - Saqib Hasan
- Infectious Disease, Hurley Medical Center, Flint, Michigan, USA
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Wani P, Antony N, Wardi M, Rodriguez-Castro CE, Teleb M. The Forgotten One: Lemierre's Syndrome Due to Gram-Negative Rods Prevotella Bacteremia. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:18-22. [PMID: 26751621 PMCID: PMC4718112 DOI: 10.12659/ajcr.895560] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Patient: Male, 22 Final Diagnosis: Lemierre’s syndrome Symptoms: Dyspnea • chest pain • swelling Medication: — Clinical Procedure: Thoracentesis Specialty: Infectious Diseases
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Affiliation(s)
- Priyanka Wani
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Nishaal Antony
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Miraie Wardi
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Carlos E Rodriguez-Castro
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Mohamed Teleb
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
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