1
|
Qi Q, Yang J, Yang L, Tian H, Wan C, Liu D. Diagnostic and Therapeutic Challenges in Lemierre Syndrome: A Case Report Using Metagenomic Next Generation Sequencing. Infect Drug Resist 2024; 17:1669-1673. [PMID: 38707986 PMCID: PMC11069072 DOI: 10.2147/idr.s455994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
Lemierre syndrome (LS) is a rare and life-threatening condition predominantly caused by Fusobacterium necrophorum. Currently, there are no standardized clinical guidelines for LS management. Here, we describe the case of a 40-year-old male with fever, productive cough, and dyspnea but no sore throat. Diagnostic radiological examinations revealed multiple pulmonary cavitary nodules and an internal jugular vein occlusion. Metagenomic Next-Generation Sequencing (mNGS) of the alveolar lavage fluid identified Fusobacterium necrophorum, thereby confirming the diagnosis of LS. Intriguingly, the patient exhibited a delayed clinical response despite receiving the appropriate antibiotic. After integrating tigecycline into the treatment to address potential co-infecting bacteria, we observed a marked improvement in his clinical symptoms. Subsequent follow-up over 12 weeks post-discharge revealed complete alleviation of symptoms, and a chest CT scan showed marked regression of the lung lesions.
Collapse
Affiliation(s)
- Qi Qi
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jun Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Linhui Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Huohuan Tian
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Chun Wan
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Dan Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| |
Collapse
|
2
|
Nallani R, Price ME, Narayanan SS, Tracy M, Arganbright J. Pediatric COVID-19 Involving Complicated Sinusitis With Intracranial Extension and Lemierre Syndrome: A Case Report. Cureus 2023; 15:e34960. [PMID: 36938258 PMCID: PMC10019002 DOI: 10.7759/cureus.34960] [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: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
Pediatric coronavirus disease 2019 (COVID-19) has been associated with various complications including chronic respiratory disease and multisystem inflammatory syndrome. There are a few reported cases of complicated sinusitis following pediatric COVID-19 infection. We present a patient with recent COVID-19 who developed complicated sinusitis with intracranial extension and Lemierre syndrome. A 16-year-old female with a history of COVID-19 diagnosis 17 days prior presented with worsening head and neck symptoms. Physical examination demonstrated left proptosis, cranial nerve (CN) VI palsy, and limited neck range of motion. Imaging demonstrated bilateral sinus disease, a 3.3 × 2 × 3-centimeter sellar/clival abscess, bilateral cavernous sinus thrombosis, and thrombosis of bilateral internal jugular veins. Urgent endoscopic sinus surgery was performed, and long-term intravenous antibiotics and anticoagulation were initiated with improvement in symptoms over three weeks. Providers caring for patients with COVID-19 should keep complicated sinusitis and Lemierre syndrome in their differential. Further study of COVID-19 pathophysiology in the sinonasal mucosa is needed.
Collapse
Affiliation(s)
- Rohit Nallani
- Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, USA
| | - Michael E Price
- Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, USA
| | | | - Meghan Tracy
- Otolaryngology, Children's Mercy Hospital, Kansas City, USA
| | | |
Collapse
|
3
|
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.
Collapse
|
4
|
Pleming W, Barco S, Voci D, Sacco C, Zane F, Granziera S, Corsi G, Konstantinides SV, Kucher N, Pecci A, Valerio L. Cardiac and Cerebral Arterial Complications of Lemierre Syndrome: Results from a Systematic Review and Individual Patient Data Meta-analysis. Hamostaseologie 2022; 42:261-267. [PMID: 35255510 PMCID: PMC9388219 DOI: 10.1055/a-1694-8723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background
Lemierre syndrome is a potentially life-threatening disease, which affects otherwise healthy young adults and adolescents. It is characterized by acute neck vein thrombosis and septic embolism, usually complicating a bacterial infection. Data on the syndrome are sparse, particularly concerning arterial complications.
Methods
We evaluated the frequency and patterns of cerebral arterial and cardiac involvement (“arterial complications”) in an individual patient level cohort of 712 patients, representing all cases described over the past 20 years in the medical literature who fulfilled the criteria: (1) bacterial infection in the neck/head site and (2) objectively confirmed thrombotic complication or septic embolism. The study outcomes were defined as all-cause in-hospital deaths and the occurrence of clinical sequelae at discharge or in the postdischarge period.
Results
A total of 55 (7.7%) patients had an arterial complication. The most frequent arterial complications were carotid involvement (52.7%), stroke (38.2%), and pericardial complications (20%). Patients with an arterial involvement were more likely to be treated with a greater number of antibiotics (23 vs. 10%) and to receive anticoagulation. In addition, patients with arterial complications had a greater risk of all-cause death (
n
= 20/600, 3.3% vs.
n
= 6/52, 12%; odds ratio [OR]: 3.8; 95% confidence interval [CI]: 1.5–9.9) and late clinical sequelae (
n
= 49/580, 9.0% vs.
n
= 15/46, 35%; OR: 5.2; 95% CI: 2.65–10.37).
Conclusions
While Lemierre syndrome is known to be primarily characterized by venous thromboembolic events, our results suggest that local or distant arterial complications may occur in approximately one-tenth of patients and may be associated with a greater risk of long-term sequelae and death.
Collapse
Affiliation(s)
- William Pleming
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Stefano Barco
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland.,Center for Thrombosis and Hemostasis, Mainz University Medical Center, Mainz, Germany
| | - Davide Voci
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Clara Sacco
- Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Federica Zane
- Department of General Medicine, Hospital of Sondrio, Sondrio, Italy
| | - Serena Granziera
- Department of Medicine, Geriatric Unit, Ospedale San Giovanni e Paolo, Venice, Italy
| | - Gabriele Corsi
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola - Malpighi Hospital, Alma Mater University, Bologna, Italy.,IRCCS Azienda Ospedaliero - Universitaria of Bologna, Bologna, Italy
| | | | - Nils Kucher
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Luca Valerio
- Center for Thrombosis and Hemostasis, Mainz University Medical Center, Mainz, Germany
| |
Collapse
|
5
|
Ge J, Zhou P, Yang Y, Xu T, Yang X. Anticoagulation may contribute to antimicrobial treatment of Lemierre syndrome: a case report. Thromb J 2021; 19:80. [PMID: 34736465 PMCID: PMC8567340 DOI: 10.1186/s12959-021-00336-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/21/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Lemierre syndrome (LS) is characterized by multisystemic infection beginning in the oropharynx, local thrombophlebitis (typically, of the internal jugular vein) and peripheral embolism. No evidence-based guidelines exist for the management of this disease, and the use of anticoagulation therapy remains particularly controversial. CASE PRESENTATION A 61-year-old man presenting with left neck swelling, odynophagia, and dyspnea underwent emergency surgery and received intravenous antibiotics. The primary infection was controlled on hospital day 5, but on day 6 sudden leukocytosis and hypoxemia were observed. CT angiography revealed an intraluminal filling defect in the pulmonary artery on day 8. LS was diagnosed and anticoagulation therapy was initiated. The WBC count, which had maintained its peak values in the previous 2 days, decreased instantly after initiation, and follow-up controls showed thrombus resolution. CONCLUSIONS Our case supports the notion that anticoagulation therapy may be a valid supplement to antimicrobial therapy in LS, especially in the presence of a possibly young thrombus as suggested by clinical worsening.
Collapse
Affiliation(s)
- Jie Ge
- Department of stomatology, Changzhou First People's Hospital, Juqian Street, Changzhou, 185, Jiangsu, China
| | - Peipei Zhou
- Department of stomatology, Changzhou First People's Hospital, Juqian Street, Changzhou, 185, Jiangsu, China
| | - Yifei Yang
- Department of stomatology, Changzhou First People's Hospital, Juqian Street, Changzhou, 185, Jiangsu, China
| | - Tianshu Xu
- Department of stomatology, Changzhou First People's Hospital, Juqian Street, Changzhou, 185, Jiangsu, China
| | - Xu Yang
- Department of stomatology, Changzhou First People's Hospital, Juqian Street, Changzhou, 185, Jiangsu, China.
| |
Collapse
|
6
|
Ageno W. Difficult challenges in vascular medicine. Minerva Med 2021; 112:698-700. [PMID: 34236159 DOI: 10.23736/s0026-4806.21.07702-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy -
| |
Collapse
|