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Cameron C, Tong JY, Patel S, Foreman A, Selva D. Disseminated thrombosis of the internal jugular vein, superior ophthalmic vein and cavernous sinus as the primary manifestation of occult malignancy: a case report. Orbit 2024; 43:505-510. [PMID: 36995033 DOI: 10.1080/01676830.2023.2186436] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/25/2023] [Indexed: 06/19/2023]
Abstract
Internal jugular vein (IJV) thrombosis is a life-threatening condition most often associated with local risk factors such as head or neck infection or central venous catheterisation. Underlying malignancy is a rare but important aetiology to consider in patients presenting with spontaneous IJV thrombosis. We describe a case of necrotic cervical lymphadenopathy with thrombosis of the IJVs, cavernous sinuses and superior ophthalmic veins in a patient with metastatic squamous cell carcinoma, which was further complicated by an orbital compartment syndrome. The differential diagnosis of IJV thrombosis includes a range of infective, metastatic and thrombophilic pathologies. This case illustrates that, in the absence of an underlying precipitating factor, spontaneous IJV thrombosis should prompt further systemic investigations. Furthermore, patients with thrombotic events affecting the orbital venous drainage system should be monitored closely for signs of an acute orbital compartment syndrome.
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Affiliation(s)
- Cassie Cameron
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Jessica Y Tong
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Institute of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sandy Patel
- Department of Radiology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Andrew Foreman
- Department of Otorhinolaryngology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dinesh Selva
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Institute of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Santos L, Monteiro F, Marques M, Homem R, Spencer V. Lemierre's Syndrome: A Case Report. Cureus 2023; 15:e34473. [PMID: 36874654 PMCID: PMC9981244 DOI: 10.7759/cureus.34473] [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 rare condition characterized by septic thrombophlebitis of the internal jugular vein secondary to infection of the head and neck region and septic embolization to other organs. The most frequent etiological agent is Fusobacterium necrophorum, a commensal anaerobic gram-negative bacillus of the oral flora. We report the case of a young male who presented with chest pain after a dental procedure. He developed a masseterian phlegmon, thrombosis of the internal jugular vein, and embolization to the lung complicated by empyema. The diagnosis of Lemierre's syndrome was delayed by the negative blood cultures, but full recovery was achieved after appropriate broad-spectrum antibiotic coverage. Our main objective is to highlight the fact that a high clinical suspicion is required to establish the diagnosis of this rare syndrome.
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Affiliation(s)
| | | | - Maria Marques
- Internal Medicine, Hospital Garcia de Orta, Almada, PRT
| | - Rita Homem
- Internal Medicine, Hospital Garcia de Orta, Almada, PRT
| | - Vanda Spencer
- Internal Medicine, Hospital Garcia de Orta, Almada, PRT
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Kundal SV, Lee J, Khalid M, Shani J, Hollander GM, Ping Z, Maung C, Shetty VS. Lemierre's Syndrome in an Elderly Female Patient with Polycythemia Vera: Does Polycythemia Vera Predispose to Lemierre's Syndrome? AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933587. [PMID: 34587148 PMCID: PMC8488186 DOI: 10.12659/ajcr.933587] [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] [Indexed: 11/09/2022]
Abstract
Patient: Female, 66-year-old
Final Diagnosis: Lemierre’s syndrome
Symptoms: Chills • neck pain • odynophagia • rigors • trismus
Medication: —
Clinical Procedure: Computed tomography
Specialty: Cardiology • Hematology • Infectious Diseases • General and Internal Medicine
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Affiliation(s)
- Sanchit V Kundal
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Jasmine Lee
- Department of Internal Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Mazin Khalid
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Jacob Shani
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA
| | | | - Zhou Ping
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Chun Maung
- Department of Internal Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Vijay S Shetty
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA
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Diagnosis and Management of Lemierre's Syndrome Presented with Multifocal Pneumonia and Cerebral Venous Sinus Thrombosis. Case Rep Infect Dis 2020; 2020:6396274. [PMID: 32231820 PMCID: PMC7085867 DOI: 10.1155/2020/6396274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/16/2020] [Indexed: 11/18/2022] Open
Abstract
A 27-year-old female patient initially presented with fever, myalgia, sore throat that progressed to multifocal pneumonia, and cerebral sinus venous thrombosis. A combination of upper respiratory symptoms with tooth infection, positive blood culture for Fusobacterium nucleatum, computed tomography (CT) chest finding of multifocal pneumonia, and magnetic resonance imaging (MRI) finding of internal jugular vein thrombosis (IJVT) and cerebral venous sinus thrombosis (CVST) suggested Lemierre syndrome. The patient was managed with fluids, antibiotics, and anticoagulants. The patient survived and discharged from the hospital. The patient's symptoms improved at 2 months of follow-up.
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Porphyromonas asaccharolytica as a Rare Causative Agent for Lemierre's Syndrome. Case Rep Infect Dis 2018; 2018:3628395. [PMID: 30533234 PMCID: PMC6247719 DOI: 10.1155/2018/3628395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 10/16/2018] [Indexed: 02/07/2023] Open
Abstract
Lemierre's syndrome is a rare disease associated with significant morbidity and mortality. It begins with an oropharyngeal infection, which spreads locally to involve the internal jugular vein causing thrombophlebitis, followed by distant spread and metastatic infections. Affected individuals are commonly young adults. Causative organisms are usually oropharyngeal flora, most commonly being the anaerobe Fusobacterium necrophorum. Porphyromonas asaccharolytica is a rare etiological agent with only three cases being reported in the literature. This case report describes a previously healthy 22-year-old man who initially presented with acute tonsillitis and was later found to have left internal jugular vein thrombophlebitis along with bilateral septic emboli to the lungs. The patient was treated with a five-week course of ampicillin-sulbactam and metronidazole. Subsequent imaging also showed progression of internal jugular vein thrombus, for which warfarin was given for three months for anticoagulation.
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6
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Abstract
Lemierre's syndrome is a rare, life-threatening condition, which may be fatal if not properly treated. This disease refers to thrombophlebitis of the internal jugular vein, which is the result of bacterial sore throat infection (usually in the form of pharyngitis) that extends into the parapharyngeal space. However, it can result from other infective foci in the ear, nose, parotid glands, and paranasal sinuses. The bacteria typically responsible is Fusobacterium necrophorum. Here, we describe a case of Lemierre's syndrome that occurred in a 20-year-old female who presented with neurological deficits following a two-week history of upper respiratory tract infection. Our case displayed typical findings of this rare condition with a review of the previous literature and also to emphasize the importance of high index of suspicion to reduce the mortality of this disease.
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Affiliation(s)
| | | | - Sawsan Taif
- Radiology Department, Khoula Hospital, Muscat, Oman
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Fischer JB, Prout A, Blackwood RA, Warrier K. Lemierre Syndrome Presenting as Acute Mastoiditis in a 2-Year-Old Girl with Congenital Dwarfism. Infect Dis Rep 2015; 7:5922. [PMID: 26294952 PMCID: PMC4508537 DOI: 10.4081/idr.2015.5922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 04/07/2015] [Accepted: 04/20/2015] [Indexed: 11/23/2022] Open
Abstract
Lemierre syndrome is defined by septic thrombophlebitis of the internal jugular vein caused by Fusobacterium. Historically, these infections originate from the oropharynx and typically are seen in older children, adolescents and young adults. More recently, otogenic sources in younger children have been described with increasing frequency. We present a case of a two-year old, who initially developed an otitis media with perforation of the tympanic membrane and went on to develop mastoiditis and non-occlusive thrombosis of the venous sinus and right internal jugular vein. Fusobacterium necrophorum was grown from operative cultures of the mastoid, ensuing computed tomography scan revealed occlusion of the internal jugular vein and the patient was successfully treated with clindamycin, ciprofloxacin and enoxaparin. This case demonstrates the importance of considering Fusobacterium in otogenic infections and the consideration of Lemierre syndrome when F. necrophorum is identified
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Affiliation(s)
- Jason B Fischer
- Department of Pediatrics and Communicable Diseases, University of Michigan , Ann Arbor, MI, USA
| | - Andrew Prout
- Department of Pediatrics and Communicable Diseases, University of Michigan , Ann Arbor, MI, USA
| | - R Alexander Blackwood
- Department of Pediatrics and Communicable Diseases, University of Michigan , Ann Arbor, MI, USA
| | - Kavita Warrier
- Department of Pediatrics and Communicable Diseases, University of Michigan , Ann Arbor, MI, USA
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