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Abuhammad A, Nassar O, Tomizi MG, Alfroukh K, Abuturki A. Case of Lemierre's Syndrome Presenting With Neuro-Ophthalmologic Complications That Worsened After Stopping Corticosteroids. Cureus 2024; 16:e53640. [PMID: 38449947 PMCID: PMC10917393 DOI: 10.7759/cureus.53640] [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: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Lemierre's syndrome (LS) is a rare disorder that manifests as septic internal jugular thrombophlebitis following a recent oropharyngeal infection. This article details a unique case of LS, where the patient presented to the emergency room with complaints of vomiting, headache, diplopia, and left eye pain. Due to a history of sore throat, headache, neck pain, fever, and nausea five days prior to admission, the patient was initially treated with amoxicillin/clavulanate for suspected tonsillitis. A positive meningeal sign and elevated temperature were observed during the clinical examination. Lumbar puncture (LP) was deferred based on imaging indicating potential increased intracranial pressure (ICP). Nevertheless, the patient received vancomycin, ceftriaxone, and dexamethasone as an initial course of treatment for presumed bacterial meningitis. Significant improvement was observed within the first four days of admission, with no subsequent episodes of fever, nausea, or headache. However, upon discontinuation of corticosteroid therapy, the patient experienced severe headaches and frequent vomiting. An urgent brain CT scan confirmed the extension of the left internal jugular vein (IJV) thrombosis to the ipsilateral sigmoid sinuses. Metronidazole and anticoagulant medication were initiated upon LS diagnosis. There is a paucity of discussions on corticosteroid use in LS, with no definitive statistics in the current literature. This case underscores the importance of recognizing and effectively managing interconnected clinical manifestations.
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Affiliation(s)
| | - Osayd Nassar
- Department of Internal Medicine, Al-Ahli Hospital, Hebron, PSE
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Denesopolis JM, Medicherla Singh RC, Shah AR, Lyon R, Chao E, Hochsztein JG, Rivera A. A unique case of Lemierre's syndrome status post blunt cervical trauma. Vascular 2020; 28:485-488. [PMID: 32228176 DOI: 10.1177/1708538120913734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Lemierre's syndrome is a rare but potentially fatal condition. The course is characterized by acute tonsillopharyngitis, bacteremia, internal jugular vein thrombosis, and septic embolization. There have been some cases secondary to penetrating trauma to the neck. Literature review has yielded no cases secondary to blunt neck trauma in the absence of oropharyngeal injury. We aim to shed light on this unique cause of Lemierre's syndrome, so as to raise the index of suspicion for clinicians working up patients with blunt cervical trauma. METHODS We present a case of a 25-year-old male restrained driver who presented with left neck and shoulder pain with a superficial abrasion to the left neck from the seatbelt who was discharged same day by the Emergency Room physicians. He returned to the Emergency Department two days later with abdominal pain. As a part of his repeat evaluation, a set of blood cultures were sent and was sent home that day. The patient was called back to the hospital one day later as preliminary blood cultures were positive for Gram positive cocci and Gram negative anaerobes. Computerized tomography scan of the neck revealed extensive occlusive left internal jugular vein thrombosis and fluid collections concerning for abscesses, concerning for septic thrombophlebitis. The patient continued to decompensate, developing severe sepsis complicated by disseminated intravascular coagulation. RESULTS The patient underwent a left neck exploration with en bloc resection of the left internal jugular vein, drainage of abscesses deep to the sternocleidomastoid, and washout/debridement of necrotic tissue. Direct laryngoscopy at the time of surgery revealed no injury to the aerodigestive tract. Wound cultures were consistent with blood cultures and grew Fusobacterium necrophorum, Staphylococcus epidermidis, and Methicillin-resistant staphylococcus aureus. The patient underwent two subsequent operative wound explorations without any evidence of residual infection. The patient was discharged home on postoperative day 13 on a course of antibiotics and aspirin. CONCLUSION This case illustrates the importance of diagnosis of Lemierre's syndrome after an unconventional inciting event (blunt cervical trauma) and appropriate treatment.
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Affiliation(s)
- John M Denesopolis
- Division of Vascular and Endovascular Surgery, Montefiore Medical Center, Bronx NY, USA.,Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Ratna C Medicherla Singh
- Division of Vascular and Endovascular Surgery, Montefiore Medical Center, Bronx NY, USA.,Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Amit R Shah
- Department of Cardiovascular and Thoracic Surgery, Jacobi Medical Center, Bronx, NY, USA.,Department of Surgery, Jacobi Medical Center, Bronx, NY, USA
| | - Ross Lyon
- Department of Cardiovascular and Thoracic Surgery, Jacobi Medical Center, Bronx, NY, USA.,Department of Surgery, Jacobi Medical Center, Bronx, NY, USA
| | - Edward Chao
- Department of Surgery, Jacobi Medical Center, Bronx, NY, USA.,Department of Trauma Surgery and Surgical Critical Care, Jacobi Medical Center, Bronx, NY, USA
| | | | - Aksim Rivera
- Department of Cardiovascular and Thoracic Surgery, Jacobi Medical Center, Bronx, NY, USA.,Department of Surgery, Jacobi Medical Center, Bronx, NY, USA
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Almohaya AM, Almutairy TS, Alqahtani A, Binkhamis K, Almajid FM. Fusobacterium bloodstream infections: A literature review and hospital-based case series. Anaerobe 2020; 62:102165. [PMID: 32004686 DOI: 10.1016/j.anaerobe.2020.102165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Infections with Fusobacterium, an anaerobic bacterium, have various clinical presentations, including bacteremia and Lemierre syndrome. Here, we report a case series of Fusobacterium bacteremia (FBB) from the largest academic center in Riyadh, Saudi Arabia, and provide a review of cases in the available literature. METHOD Records were retrospectively reviewed for all patients with at least one blood culture positive for Fusobacterium spp. admitted at King Khalid University Hospital, Riyadh, Saudi Arabia, between May 2015 to April 2019. LITERATURE REVIEW We conducted a MeSH Search on MedLine using the following terms: ("Bacteremia"[Mesh]) AND "Fusobacterium"[Mesh] for studies conducted from January 1, 1990, until March 30, 2019, excluding articles that lacked adequate clinical or microbiological details for individuals patients. Odds ratios and results of Chi-Square testing obtained in SPSS (Version 23.0, SPSS, Inc., Chicago, IL, USA) were considered statistically significant at p-values < 0.05. RESULTS Seven cases from our center and 205 cases from the literature were reviewed in this first reported case series for the region. Our patient series was similar to previous ones in terms of median age (45 vs. 45.5 years) and male predominance (85% vs. 65.9%). The species of Fusobacterium cultured from our cases were F. nucleatum (4 cases), F. varium (1 case), F. mortiferum (1 case), and one that could not be identified to the species level (1 case). We also report one case of FBB with renal vein thrombosis resembling that of atypical Lemierre syndrome. Analysis of literature cases revealed that bacteremia caused by the species most commonly associated with FBB, F. necrophorum, tended to be present in patients less than 40 years of age and be associated with head and neck infections and other complications, whereas F. nucleatum tended to affect people more than 40 years of age and be associated with mortality. CONCLUSION Although FBB is rarely reported in the literature, this case series and review of the literature suggests it is associated with morbidity and mortality. The type and duration of therapy used in these cases are underreported. Further research is needed to determine the most appropriate screening approach for FBB-associated complications and explore the relationship between FBB and specific malignancies, as well as optimal treatment type and duration.
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Affiliation(s)
- Abdulellah Musaid Almohaya
- Infectious Diseases Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Talal Saad Almutairy
- Microbiology Unit, Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pathology and Clinical Laboratory Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulah Alqahtani
- Microbiology Unit, Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Microbiology and Immunology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Khalifa Binkhamis
- Microbiology Unit, Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad Mohammed Almajid
- Infectious Diseases Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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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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Talupula RM, Ray A, Manchanda S, Sood R. Reverse Lemierre’s syndrome: a case report. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2018. [DOI: 10.4103/ejb.ejb_93_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lemierre's Syndrome: Recognising a Typical Presentation of a Rare Condition. Case Rep Infect Dis 2015; 2015:797415. [PMID: 25692056 PMCID: PMC4323061 DOI: 10.1155/2015/797415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/07/2015] [Accepted: 01/07/2015] [Indexed: 11/29/2022] Open
Abstract
Lemierre's syndrome is a rare complication following an acute oropharyngeal infection. The aetiological agent is typically anaerobic bacteria of the genus Fusobacterium. The syndrome is characterised by a primary oropharyngeal infection followed by metastatic spread and suppurative thrombophlebitis of the internal jugular vein. If left untreated, Lemierre's syndrome carries a mortality rate of over 90%. Whilst relatively common in the preantibiotic era, the number of cases of Lemierre's syndrome subsequently declined with the introduction of antibiotics. With the increase of antibiotic resistance and a greater reluctance to prescribe antibiotics for minor conditions such as tonsillitis, there are now concerns developing about the reemergence of the condition. This increasing prevalence in the face of an unfamiliarity of clinicians with the classical features of this “forgotten disease” may result in the misdiagnosis or delay in diagnosis of this potentially fatal illness. This case report illustrates the delay in diagnosis of probable Lemierre's syndrome in a 17-year-old female, its diagnosis, and successful treatment which included the use of anticoagulation therapy. Whilst there was a positive outcome, the case highlights the need for a suspicion of this rare condition when presented with distinctive signs and symptoms.
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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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Wahab D, Bichard J, Shah A, Mann B. Just a sore throat? Uncommon causes of significant respiratory disease. BMJ Case Rep 2013; 2013:bcr-2013-008739. [PMID: 23632177 DOI: 10.1136/bcr-2013-008739] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present two uncommon underlying causes of a sore throat which, if missed or delayed in diagnosis, can lead to disastrous consequences. Our first case is of Lemierre's syndrome diagnosed in a 21-year-old man presenting with a 5-day history of sore throat, fever, right-sided pleuritic chest pain and bilateral pulmonary nodules on CT imaging. Fusobacterium necrophorum cultured from peripheral blood and an occluded left internal jugular vein on ultrasound lead to an eventual diagnosis. Our second case presents a 29-year-old woman with a 5-day history of sore throat, fever and right-sided pleuritic chest pain. A left-sided quinsy was diagnosed and aspirated and the patient was discharged home. She represented shortly with worsening pleuritic pain and was found to have a right-sided pleural effusion with descending mediastinitis originating from the tonsillar abscess. Delayed diagnosis resulted in open thoracotomy, decortication and prolonged intravenous antibiotics.
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Affiliation(s)
- Dalia Wahab
- Department of Respiratory, Royal Brompton Hospital, London, UK.
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Mação P, Cancelinha C, Lopes P, Rodrigues F. An 11-year-old boy with pharyngitis and cough: Lemierre syndrome. BMJ Case Rep 2013; 2013:bcr-2012-008527. [PMID: 23616317 DOI: 10.1136/bcr-2012-008527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The authors present the case of an 11-year-old boy with pharyngitis, treated with amoxicillin, that worsened on day 7, with cough, high fever and refusal to eat. Lethargy and respiratory distress were noted. Based on radiographic findings of bilateral infiltrates he was diagnosed with pneumonia and started on intravenous ampicillin and erythromycin. Two days later he complained of right-sided neck pain and a palpable mass was identified. An ultrasound showed partial thrombosis of the right internal jugular vein and a lung CT scan revealed multiple septic embolic lesions. Lemierre syndrome was diagnosed, antibiotic treatment adjusted and anticoagulation started. A neck CT-scan showed a large parapharyngeal abscess. His clinical condition improved gradually and after 3 weeks of intravenous antibiotics he was discharged home on oral treatment. This case illustrates the importance of diagnosing Lemierre syndrome in the presence of pharyngitis with localised neck pain and respiratory distress, to prevent potentially fatal complications.
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Affiliation(s)
- Patricia Mação
- Department of Emergency Service and Infectious Disease Unit, Hospital Pediátrico Coimbra, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal.
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