Early Diagnosis and Antibiotic Treatment Combined with Multicomponent Hemodynamic Support for Addressing a Severe Case of Lemierre's Syndrome

Lemierre's Syndrome in a 16-Year-Old Man Associated with Resolution of Marked Widespread St Elevation and a Normal Troponin Level

A 16-year-old man presented to the Accident and Emergence services with a 10-day history of shortness of breath, sore throat, vomiting, diarrhoea, poor oral intake, chest pain, jaundice, diplopia and reduced urine output. He was initially treated for sepsis, however, subsequent imaging and blood cultures confirmed the diagnosis of Lemierre's syndrome (LS). LS, also known as necrobacillosis or post-pharyngitis anaerobic septicaemia is comprised of a triad of metastatic septic emboli secondary to pharyngitis, bacteraemia, and internal jugular vein thrombophlebitis. Fusobacterium necrophorum, a Gram-negative anaerobe, is the most common culprit of LS, followed by Fusobacterium nucleatum and anaerobic bacteria such as streptococci, staphylococci, and Klebsiella. LS is also called the forgotten syndrome because although use of antibiotics at first decreased the prevalence of LS, resistance to antibiotics has caused a rise in LS and it is no longer a forgotten disease. LS should be on the differential diagnosis of chest empyema if it follows pharyngitis or tonsillitis with neck pain, lymphadenopathy and sepsis, hence taking a thorough history is the key to diagnose it earlier. It is paramount to do chest X-ray, Doppler ultrasound of the neck veins and computed tomography (CT) scan of the neck and chest to look for features of LS. LS can be fatal if not diagnosed and treated properly. Empirical antibiotic therapy should be prescribed for a minimum of 3 weeks and should cover anaerobic bacteria and Gram-negative rods.

LEARNING POINTS

The incidence of Lemierre's syndrome (LS) is rising possibly to antibiotic resistance and fewer tonsillectomies which should increase awareness of the signs and symptoms of LS. It is no longer the forgotten disease.Pharyngitis can have serious complications including glomerulonephritis, rheumatic fever, and tonsillar cysts. However, LS is one of the most fatal complications of pharyngitis and must certainly be considered in the differential diagnoses.Even if the sore throat resolves post oropharyngeal infection or the blood culture comes back negative, if the patient is feeling unwell, this should be treated as a red flag for further investigations. Prompt investigation and management of LS is the key to saving patient's life as the mortality rate in LS is high.

A Rare Case of Lemierre's Syndrome Caused by Streptococcus pyogenes

Lemierre's syndrome (LS) is a rare condition characterized by septic thrombophlebitis of the internal jugular vein (IJV). Typically, the primary infection originates in the oropharynx, progressing to the lateral pharyngeal space, IJV, and potentially leading to bacteremia. Through septic embolization, these patients can develop severe complications, underscoring the importance of early diagnosis. We present a case of LS in a 33-year-old female who initially presented to the emergency department with odynophagia and was diagnosed with acute tonsillitis. She was discharged with antibiotics. However, one week later, she returned with sudden-onset dyspnea. After a comprehensive workup during her hospital stay, an LS caused by Streptococcus pyogenes was diagnosed. The patient was treated with anticoagulation and antibiotics, resulting in a favorable clinical outcome. This case highlights the importance of maintaining a high level of clinical suspicion for LS in the differential diagnosis of complicated tonsillitis, emphasizing the critical role of early identification and appropriate management. Additionally, we aim to review the pathophysiology, management strategies, and current literature on LS, offering insights into the clinical approach to these rare yet potentially fatal cases.

Editorial for the Special Issue: "Current and Novel Antimicrobial Strategies for Bacterial and Fungal Infections by Resistant Organisms"

The pandemic driven by the SARS-CoV-2 infection has compelled health services globally to direct all available human and economic resources toward fighting the novel coronavirus [...].