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Newman N, Bantikassegn A, West TG, Peacock JE. An Unusual Etiology of Lemierre-Like Syndrome: Preseptal Cellulitis due to Methicillin-Resistant Staphylococcus aureus. Open Forum Infect Dis 2022; 9:ofac143. [PMID: 35531375 PMCID: PMC9070346 DOI: 10.1093/ofid/ofac143] [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: 01/14/2022] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
Lemierre’s syndrome (LS) is a rare and potentially fatal condition that predominantly affects young adults with oropharyngeal infection. Fusobacterium necrophorum is the usual etiology and classically causes internal jugular vein septic thrombophlebitis, frequently complicated by septic emboli to several organs (most classically to the lungs). Lemierre-like syndrome (LLS) describes the same constellation of symptoms and pathophysiology as Lemierre’s syndrome; however, Fusobacterium spp. are not the cause, and the source of infection may be nonoropharyngeal. We present a case with an unusual etiology of LLS: a patient with untreated preseptal cellulitis and associated methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in the setting of injection drug use. Physical exam revealed tachypnea and rhonchi with severe periorbital and bilateral eyelid edema. Imaging demonstrated bilateral preseptal and orbital cellulitis with thrombosis of both internal jugular veins and bilateral pulmonary cavitary lesions consistent with septic pulmonary emboli. She was managed with anticoagulation and parenteral antibiotics. To our knowledge, this is the first case of LLS originating from preseptal cellulitis without evidence of preceding pharyngitis. While facial and orbital infections are rare etiologies of LLS, the potentially devastating sequelae of LLS warrant its inclusion in differential diagnoses.
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Affiliation(s)
- Noah Newman
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amlak Bantikassegn
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Thomas G West
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - James E Peacock
- Division of Infectious Disease, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Klug TE, Greve T, Hentze M. Complications of peritonsillar abscess. Ann Clin Microbiol Antimicrob 2020; 19:32. [PMID: 32731900 PMCID: PMC7391705 DOI: 10.1186/s12941-020-00375-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022] Open
Abstract
Background The vast majority of patients with peritonsillar abscess (PTA) recover uneventfully on abscess drainage and antibiotic therapy. However, occasionally patient´s condition deteriorates as the infection spread in the upper airway mucosa, through cervical tissues, or hematogenously. The bacterial etiology of PTA is unclarified and the preferred antimicrobial regimen remains controversial. The current narrative review was carried out with an aim to (1) describe the spectrum of complications previously recognized in patients with peritonsillar abscess (PTA), (2) describe the bacterial findings in PTA-associated complications, and (3) describe the time relation between PTA and complications. Methods Systematic searches in the Medline and EMBASE databases were conducted and data on cases with PTA and one or more complications were elicited. Results Seventeen different complications of PTA were reported. The most frequently described complications were descending mediastinitis (n = 113), para- and retropharyngeal abscess (n = 96), necrotizing fasciitis (n = 38), and Lemierre´s syndrome (n = 35). Males constituted 70% of cases and 49% of patients were > 40 years of age. The overall mortality rate was 10%. The most prevalent bacteria were viridans group streptococci (n = 41, 25%), beta-hemolytic streptococci (n = 32, 20%), F. necrophorum (n = 21, 13%), S. aureus (n = 18, 11%), Prevotella species (n = 17, 10%), and Bacteroides species (n = 14, 9%). Simultaneous diagnosis of PTA and complication was more common (59%) than development of complication after PTA treatment (36%) or recognition of complication prior to PTA (6%). Conclusion Clinicians involved in the management of PTA patients should be aware of the wide range of complications, which may arise in association with PTA development. Especially males and patients > 40 years of age seem to be at an increased risk of complicated disease. In addition to Group A streptococci and F. necrophorum, the current findings suggest that viridans group streptococci, S. aureus, Prevotella, and Bacteroides may also play occasional roles in the development of PTA as well as spread of infection. Complications occasionally develop in PTA patients, who are treated with antibiotics and surgical drainage.
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Affiliation(s)
- Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99 Aarhus N, Aarhus, 8200, Denmark.
| | - Thomas Greve
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Malene Hentze
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99 Aarhus N, Aarhus, 8200, Denmark
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Rohowetz LJ, Gratton SM, Dansdill D, Miller CJ, Dubin S. Cavernous sinus thrombosis caused by Streptococcus constellatus-associated Lemierre syndrome presenting as an isolated abducens nerve palsy. Am J Ophthalmol Case Rep 2020; 18:100592. [PMID: 32123771 PMCID: PMC7037586 DOI: 10.1016/j.ajoc.2020.100592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/15/2019] [Accepted: 01/02/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose To describe a patient with Streptococcus constellatus-associated Lemierre syndrome complicated by eventual cavernous sinus thrombosis (CST) that manifested as an isolated abducens nerve palsy. Observations A patient with a history of heavy alcohol use presented with Lemierre syndrome caused by an odontogenic infection due to Streptococcus constellatus. Despite initiation of intravenous antibiotics and eventual eradication of her bacteremia, she developed an isolated abducens nerve palsy on hospital day 7 due to associated CST. Conclusions and Importance CST is a rare complication of odontogenic infection and Lemierre syndrome. This case demonstrates the potential for primary odontogenic infections to progress to life- and sight-threatening diseases. This case also illustrates the importance of considering uncommon pathogens as the etiology of CST based on the suspected source of primary infection.
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Affiliation(s)
| | | | | | | | - Sarah Dubin
- Corresponding author. Department of Internal Medicine University of Missouri, Kansas City 2411 Holmes St, Kansas City, MO, 64108, 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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Gupta T, Parikh K, Puri S, Agrawal S, Agrawal N, Sharma D, DeLorenzo L. The forgotten disease: Bilateral lemierre's disease with mycotic aneurysm of the vertebral artery. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:230-4. [PMID: 24883173 PMCID: PMC4038640 DOI: 10.12659/ajcr.890449] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 02/17/2014] [Indexed: 11/09/2022]
Abstract
Patient: Male, 25 Final Diagnosis: Lemierre’s disease Symptoms: Back pain • fever • headache • tachycardia • tachypnoe Medication: — Clinical Procedure: — Specialty: Infectious Diseases
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Affiliation(s)
- Tanush Gupta
- Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, U.S.A
| | - Kaushal Parikh
- Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, U.S.A
| | - Sonam Puri
- Department of Internal Medicine, University of Connecticut, Farmington, CT, U.S.A
| | - Sahil Agrawal
- Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, U.S.A
| | - Nikhil Agrawal
- Department of Internal Medicine, University of Florida, Gainesville, FL, U.S.A
| | - Divakar Sharma
- Department of Pulmonary and Critical Care, Westchester Medical Center, New York Medical College, Valhalla, NY, U.S.A
| | - Lawrence DeLorenzo
- Department of Pulmonary and Critical Care, Westchester Medical Center, New York Medical College, Valhalla, NY, U.S.A
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Bird NTE, Cocker D, Cullis P, Schofield R, Challoner B, Hayes A, Brett M. Lemierre's disease: a case with bilateral iliopsoas abscesses and a literature review. World J Emerg Surg 2014; 9:38. [PMID: 24904685 PMCID: PMC4046005 DOI: 10.1186/1749-7922-9-38] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 04/17/2014] [Indexed: 12/05/2022] Open
Abstract
Lemierre's disease is characterized by sepsis, often with an oropharyngeal source, secondary septic emboli and internal jugular vein thrombosis (Lancet 1:701-3, 1936. Clin Microbiol Rev 20(4):622-59, 2007). Septic emboli affecting many bodily sites have been reported, including the lungs, joints, bones, and brain. The case report describes an unusual case of Lemierre's disease in a 64 year old gentleman causing profound sepsis, acute kidney injury, bilateral iliopsoas abscesses and a right hand abscess. To our knowledge, this is the first reported case of Lemierre's disease in the context of bilateral psoas abscesses, and highlights the ambiguity surrounding the definition of Lemierre's disease. The clinical literature review highlights the difficulty in definitively diagnosing the condition and offers some suggestions for recognising and refining the diagnostic criterion of Lemierre's.
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Affiliation(s)
- Nicholas TE Bird
- General Surgery, University Hospital Aintree, Lower Lane, Liverpool L97AL, UK
| | - Derek Cocker
- Infectious Diseases, Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - Paul Cullis
- General Surgery, Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - Richard Schofield
- General Surgery, Warrington Hospital, Lovely Lane, Warrington WA5 1QG, UK
| | - Ben Challoner
- General Surgery, University Hospital Aintree, Lower Lane, Liverpool L97AL, UK
| | - Alastair Hayes
- General Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - Martin Brett
- General Surgery, Warrington Hospital, Lovely Lane, Warrington WA5 1QG, UK
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DeGaffe GH, Murphy JR, Butler IJ, Shelburne J, Heresi GP. Severe narrowing of left cavernous carotid artery associated with Fusobacterium necrophorum infection. Anaerobe 2013; 22:118-20. [DOI: 10.1016/j.anaerobe.2013.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/01/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
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Stauffer C, Josiah AF, Fortes M, Menaker J, Cole JW. Lemierre syndrome secondary to community-acquired methicillin-resistant Staphylococcus aureus infection associated with cavernous sinus thromboses. J Emerg Med 2012; 44:e177-82. [PMID: 22989693 DOI: 10.1016/j.jemermed.2012.02.075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/04/2011] [Accepted: 02/13/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Lemierre Syndrome (LS) is a highly aggressive rare disease process with a predilection for young, healthy adolescents. Often beginning with a primary cervicofacial infection, LS rapidly progresses to thrombophlebitis of the cerebral vasculature, metastatic infection, and septicemia. Untreated LS can be rapidly fatal. Thrombus within the cerebral vasculature can have devastating neurological effects. Advances in antibacterial therapy have resulted in a global decline in the incidence of LS, and clinicians may not consider LS early in the disease process. Although the mortality of LS has declined, the morbidity associated with the disease has increased, particularly the neurological sequelae. OBJECTIVES This report will provide readers with a better understanding of the etiology, clinical presentation, evaluation methods, and appropriate treatment of LS. CASE REPORT We present an atypical case of LS secondary to community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infection progressing to bilateral cavernous sinus and ophthalmic vein thromboses with resultant binocular vision loss secondary to optic nerve and retinal ischemia. CONCLUSION This case highlights the importance of early recognition of LS in the setting of a community-acquired MRSA infection as the unifying condition in a young patient with multiple acute neurologic impairments.
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Affiliation(s)
- Craig Stauffer
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Skull base osteomyelitis and potential cerebrovascular complications in children. Pediatr Radiol 2012; 42:867-74. [PMID: 22426472 DOI: 10.1007/s00247-011-2340-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 11/24/2011] [Accepted: 12/05/2011] [Indexed: 10/28/2022]
Abstract
Skull base osteomyelitis is an aggressive, life-threatening infection that can be challenging to diagnose and treat. It occurs predominantly in elderly immunocompromised patients, but it has also been reported in children with normal immunological status. Typical skul base osteomyelitis arises as a complication to ear infection mainly involving the temporal bone and is usually caused by Pseudomonas aeruginosa. Atypical or central skul base osteomyelitis originates from paranasal infections, is primarily centred on the clivus and is usually caused by Aspergillus, Pseudomonas, Salmonella or Staphylococcus species. Potential complications include retropharyngeal abscesses, cranial neuropathies, meningitis, intracranial abscesses, sinovenous thrombosis, and carotid artery involvement with or without ischemic infarcts. The purpose of this pictorial essay is to illustrate the spectrum of imaging findings and potential complications of skul base osteomyelitis.
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Yamaguchi M, Nishizawa H, Yasumoto T, Kimura T, Takeuchi Y, Takeshita A, Takase T, Fujimoto H, Nakano M, Fukunaga M. Lemierre syndrome with blepharoptosis. Intern Med 2010; 49:753-7. [PMID: 20424365 DOI: 10.2169/internalmedicine.49.2779] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 51-year-old woman was hospitalized with a high fever, occipital pain, blepharoptosis, and trismus. Enhanced CT showed thrombophlebitis of her left cavernous sinus, maxillary vein, and multiple pulmonary nodular lesions. (18)F-FDG PET/CT showed significant uptakes in the same lesions. Streptococcus constellatus was detected in her blood. Therefore, she was diagnosed as a Lemierre syndrome variant. After administration of antibiotics, all symptoms, inflammatory reactions, and thrombi disappeared. Since Lemierre syndrome has life-threatening potential, early diagnosis and initiation of appropriate therapy are important. In this case, (18)F-FDG PET/CT was useful to detect the focus and extent of infection.
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Affiliation(s)
- Megu Yamaguchi
- Department of Internal Medicine, Toyonaka Municipal Hospital
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Abstract
Lemierre's syndrome is a rare disease in young otherwise healthy people showing septic embolism in the lungs and peripheral vessels. We report the case of a 19-year-old male patient who presented initially with a phlegmon of the right palm and beginning septic shock. During the clinical course a subcutaneous abscess of the left shoulder, multiple lesions of the lungs and a pericardial abscess were identified and Lemierre's syndrome was diagnosed. In this case, positron emission tomography (PET) was revealed to be an appropriate instrument to determine the extent of the disease in a one step procedure.
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