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Carreras X, Salcedo AS, Ponce-Rosas L, Gonzales-Zamora JA, Diaz N, Alave J. Lemierre-like syndrome after soft tissue infection due to methicillin-resistant Staphylococcus aureus: A case report and literature review. Medicine (Baltimore) 2024; 103:e37006. [PMID: 38363930 PMCID: PMC10869080 DOI: 10.1097/md.0000000000037006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/29/2023] [Indexed: 02/18/2024] Open
Abstract
RATIONALE Lemierre-like syndrome (LLS) is characterized by bacteremia, septic thrombophlebitis of the internal jugular vein, and metastatic abscesses. In contrast to classic Lemierre syndrome, sources of infection are not related to oropharyngeal infections, as are frequent soft tissue infections. In recent years, Staphylococcus aureus has been identified as an emergent pathogen that causes this syndrome. The mortality rate of LLS caused by this pathogen is approximately 16%. Timely diagnosis, antibiotic treatment, and infection control are the cornerstones to treat LLS. Anticoagulant therapy as adjuvant treatment remains controversial. PATIENT CONCERNS A 31-year-old woman from California, United States (US), was admitted to the emergency room with a history of 2 days of fever and severe throbbing pain in the left cervical region. Thorax and neck CT tomography revealed confluent cavities suggestive of septic embolism in the lungs and a filiform thrombus in the lumen of the left internal jugular vein, with moderate swelling of the soft and muscular tissues. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from the blood culture. DIAGNOSIS The thrombus in the internal jugular vein associated with cellulitis in the neck and multiple cavitary lesions in the lungs support the diagnosis of LLS caused by MRSA with septic embolization. INTERVENTIONS During treatment, the patient received vancomycin IV for 25 days and returned to the US with linezolid orally. In addition, assisted video-thoracoscopy and bilateral mini-thoracotomy with pleural decortication were performed for infectious source control, where 1700cc of purulent pleural fluid was drained. OUTCOMES The patient was discharged with optimal evolution. LESSONS LLS should be suspected in patients with skin and soft tissue infections who develop thrombosis or metastatic infections. MRSA infections should be considered in patients from areas where this pathogen is prevalent.
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Affiliation(s)
- Xosse Carreras
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Andrea S. Salcedo
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Linda Ponce-Rosas
- Department of Medicine, Hamilton Medical Center, Dalton, GA 30720
- Peruvian American Medical Society, Albuquerque, NM
| | - Jose A. Gonzales-Zamora
- Peruvian American Medical Society, Albuquerque, NM
- Division of Infectious Diseases, Department of Medicine, University of Miami, Miller School of Medicine, FL 33136
| | - Nelson Diaz
- School of Medicine, Universidad Peruana Union, Lima, Peru
- Department of Internal Medicine, Clínica Good Hope, Lima, Peru
| | - Jorge Alave
- School of Medicine, Universidad Peruana Union, Lima, Peru
- Department of Internal Medicine, Clínica Good Hope, Lima, Peru
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2
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Kodaka N, Nakano C, Oshio T, Matsuse H. Lemierre syndrome complicated by bronchopleural fistula. J Postgrad Med 2024; 70:50-52. [PMID: 37376756 PMCID: PMC10947735 DOI: 10.4103/jpgm.jpgm_722_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 06/29/2023] Open
Abstract
We present a 19-year-old woman, a case of Lemierre syndrome, who presented with fever, sore throat, and left shoulder pain. Imaging revealed a thrombus in the right internal jugular vein, multiple nodular shadows below both pleura with some cavitations, right lung necrotizing pneumonia, pyothorax, abscess in the infraspinatus muscle, and multiloculated fluid collections in the left hip joint. After inserting a chest tube and administering urokinase for the pyothorax, a bronchopleural fistula was suspected. The fistula was identified based on clinical symptoms and computed tomography scan findings. If a bronchopleural fistula is present, thoracic lavage should not be performed as it may cause complications such as contralateral pneumonia due to reflux.
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Affiliation(s)
- N Kodaka
- Division of Respiratory Medicine, Department of Internal Medicine, Toho University Ohashi Medical Center, Meguro City, Tokyo, Japan
| | - C Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Toho University Ohashi Medical Center, Meguro City, Tokyo, Japan
| | - T Oshio
- Division of Respiratory Medicine, Department of Internal Medicine, Toho University Ohashi Medical Center, Meguro City, Tokyo, Japan
| | - H Matsuse
- Division of Respiratory Medicine, Department of Internal Medicine, Toho University Ohashi Medical Center, Meguro City, Tokyo, Japan
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3
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Onozawa S, Someya F, Yokogawa M. Effects of Physical Therapy on a Patient With Lemierre's Syndrome Who Had Atelectasis and Limited Range of Motion in the Neck. Cureus 2023; 15:e45533. [PMID: 37868520 PMCID: PMC10586077 DOI: 10.7759/cureus.45533] [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: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Lemierre's syndrome (LS) is a severe infectious disease that can lead to the formation of neck abscesses and thrombosis. LS may be an indication for surgery; however, there are few reports on the physical therapy approaches used in patients with LS. A male patient in his 20s reported atelectasis and limited range of motion in the neck after resection of a deep neck abscess on the left side of the neck caused by LS. Thrombophlebitis was also observed around the neck lesion, indicating the risk of pulmonary embolism. Physical therapy was initiated with low-load, deep breathing exercises. Additional breathing exercises, such as respiratory assistance and positive pressure loading, were initiated after the administration of anticoagulants. Although the therapeutic intervention was delayed due to the unstable wound with partially resected muscle, it was assumed that the impairment of the range of motion in the neck was unlikely to persist as the patient was young. No critical adverse events were observed, and the range of motion was recovered such that the patient was able to resume playing baseball. The presence of a venous thrombus and inflammation may affect physical therapy; however, careful management of the exercise load could aid in the safe and effective treatment of LS without the incidence of complications, even in the early postoperative period.
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Affiliation(s)
- Shinichi Onozawa
- Rehabilitation Center, Asanogawa General Hospital, Kanazawa, JPN
- Department of Physical Therapy, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, JPN
| | - Fujiko Someya
- Faculty of Health and Medical Sciences, Hokuriku University, Kanazawa, JPN
| | - Masami Yokogawa
- Department of Physical Therapy, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, JPN
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Nur Iyow S, Uzel M, Ibrahim IG, Artan Abdi A, Farah Yusuf Mohamud M. Lemierre Syndrome: Incidental Finding of Forgotten Fatal Disease as a Complication of Ludwig's Angina. Open Access Emerg Med 2023; 15:259-263. [PMID: 37502097 PMCID: PMC10370408 DOI: 10.2147/oaem.s408470] [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: 03/10/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023] Open
Abstract
Lemierre syndrome (LS) is a rare, life-threatening complication of oropharyngeal infections associated with septicemia and internal jugular thrombosis. Internal jugular vein thrombosis is an uncommon disease associated with central vein catheterization, intravenous drug abuse, hypercoagulability, trauma to the neck, infection, ovarian hyperstimulation syndrome (OHSS), and systemic infections. Here, we highlight a case of a 62-year-old women who presented progressively worsening neck swelling for three weeks, shortness of breath, and fever for four days. Her sepsis due to Ludwig's angina was accompanied by septic pulmonary embolism and internal jugular vein thrombosis in keeping with a diagnosis of Lemierre syndrome. For this presentation of Lemierre syndrome, the treating physicians recommended surgical excision and drainage, followed by intravenous antibiotics and subcutaneous anticoagulation to treat septic emboli of the lungs and internal jugular veins. Sadly, after being informed about the procedure, the patient refused to consent, and four days later, she passed away. It is essential to remember that early detection and aggressive treatment may significantly impact prognosis and outcome.
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Affiliation(s)
- Sowdo Nur Iyow
- Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Muzeyyen Uzel
- Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
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Liu Y, Yu Y, Dai H, Fei A. Efficacy of Shufeng Jiedu Capsules in the treatment of sepsis: A prospective, randomized, placebo-controlled trial. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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6
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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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7
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Habib S, Rajdev K, Siddiqui A, Azam M, Memon A, Chalhoub M. Septic emboli of the lung due to Fusobacterium necrophorum, a case of Lemierre's syndrome. Respir Med Case Rep 2019; 28:100867. [PMID: 31211045 PMCID: PMC6562267 DOI: 10.1016/j.rmcr.2019.100867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/26/2019] [Accepted: 05/27/2019] [Indexed: 11/18/2022] Open
Abstract
Fusobacterium necrophorum plays a causal role in a rare and life-threatening condition, Lemierre's syndrome. It is characterized by infection involving the posterior compartment of the lateral pharyngeal space complicated by septic suppurative thrombophlebitis of the internal jugular vein with F. necrophorum bacteremia and metastatic abscesses, primarily to the lung and pulmonary septic emboli. Herein, we present a very rare case of oropharyngeal infection complicated by Lemierre's syndrome with characteristic septic emboli to the lungs presenting as sore throat in a previously healthy patient. A 23-year-old woman presented with sore throat and was found to be in sepsis and acute kidney injury. She was found to have septic emboli in lung and Streptococcus anginosus and F. necrophorum in blood. She was diagnosed with Lemierre's syndrome and successfully treated with antibiotics. Lemierre's syndrome should be included in the differential diagnosis in young patients who deteriorate in the setting of a sore throat. If the suspicion is high, throat swabs from young patients with nonstreptococcal group A tonsillitis should be cultured anaerobically on selective medium to detect the presence of F. necrophorum. While clinicians of the infectious disease team may be familiar with this condition other departments including internal medicine and critical care team may less so. Unless clinicians are aware of this syndrome, diagnosis and treatment can be delayed leading to higher morbidity and mortality.
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Affiliation(s)
- Saad Habib
- Department of Internal Medicine, Staten Island University Hospital, USA
| | - Kartikeya Rajdev
- Department of Internal Medicine, Staten Island University Hospital, USA
| | - A.H. Siddiqui
- Department of Pulmonary & Critical Care, Staten Island University Hospital, USA
| | - Mohammed Azam
- Department of Internal Medicine, Staten Island University Hospital, USA
| | - Asma Memon
- Department of Internal Medicine, Staten Island University Hospital, USA
| | - Michel Chalhoub
- Department of Pulmonary & Critical Care, Staten Island University Hospital, USA
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8
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Correia MS, Sadler C. Methicillin-Resistant Staphylococcus aureus Septic Internal Jugular Thrombophlebitis: Updates in the Etiology and Treatment of Lemierre's Syndrome. J Emerg Med 2019; 56:709-712. [PMID: 31229258 DOI: 10.1016/j.jemermed.2019.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 03/14/2019] [Accepted: 03/19/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Lemierre's syndrome is classically precipitated by oropharyngeal infections that progress to suppurative internal jugular vein thrombophlebitis via direct extension. Metastatic pneumonia from septic emboli is nearly universal and bacterial seeding frequently results in disseminated septic foci. Fusobacterium necrophorum is the most commonly reported etiologic agent, though methicillin-resistant Staphylococcus aureus (MRSA) is an emerging pathogen and a myriad of oropharyngeal flora must be covered until blood cultures return. Prompt identification is paramount to minimizing morbidity. Empiric treatment with antibiotics exhibiting predominantly anaerobic activity has been standard, but now may be insufficient, given an evolving microbial landscape. Anticoagulation continues to be debated. CASE REPORT We describe an uncommon presentation of Lemierre's syndrome in a diabetic patient secondary to MRSA, where the only identifiable source of entry was atraumatic post-auricular cellulitis. Why Should an Emergency Physician Be Aware of This? Given the evolving landscape of organisms implicated in septic internal jugular thrombophlebitis, empiric treatment should entail consideration of MRSA. Patients at an elevated risk include those who are undomiciled or incarcerated, injection drug users, human immunodeficiency virus-positive, and have recently been hospitalized or completed a course of antibiotics. The existing evidence evaluating empiric anticoagulation is low-powered and retrospective and would benefit from randomized controlled trials. Although it does not appear valuable for most, those with thrombus extension, persistent bacteremia, or central venous thrombosis may benefit.
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Affiliation(s)
- Matthew S Correia
- Department of Emergency Medicine, University of California, San Diego, California
| | - Charlotte Sadler
- Department of Emergency Medicine, University of California, San Diego, California
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9
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Veras RDO, Barasuol LL, de Lira CP, Klostermann FC, Müller LS, Nercolini LE, Nogueira GF. Lemierre syndrome: case report. J Vasc Bras 2019; 17:337-340. [PMID: 30787954 PMCID: PMC6375262 DOI: 10.1590/1677-5449.002418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Lemierre syndrome is characterized by septic thrombophlebitis of the internal jugular vein, after an oropharyngeal infection, with septic embolization to the lungs or other organs. This case report describes a 37-year-old female patient who presented with edema and pain in the right hemiface with onset 3 days previously and progressive fatigue and dyspnea since the previous day. She had had tooth 48 extracted 3 days previously. Physical examination at admission found tachypnea, with 60% saturation (in room air), edema at the angle of the right mandible, diffuse reduction of vesicular murmur, and calves free from clubbing. Angiotomography of the chest and laboratory tests were compatible with septic emboli, and cervical computed tomography confirmed a diagnosis of septic thrombophlebitis of the internal jugular vein. She was managed with antibiotics and given treatment for her symptoms. Lemierre syndrome most often occurs in young men and there is embolization to the lungs in up to 97% of cases. Rarely, the etiology of this syndrome may be tooth extraction. Computed tomography is the imaging method most often used for diagnosis and treatment is basically antibiotic. Surgery is thus rarely necessary.
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Affiliation(s)
| | | | | | | | | | | | - Gustavo Fabiano Nogueira
- Hospital Universitário Evangélico de Curitiba - HUEC, Curitiba, PR, Brasil.,Instituto Neurológico de Curitiba - INC, Curitiba, PR, Brasil
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10
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Yang X, Yang YF, Zhu ZC, Xu TS, Cheng YN, Sun ZY. Senile Lemierre syndrome complicated with descending necrotizing mediastinitis: A case report. Medicine (Baltimore) 2018; 97:e11903. [PMID: 30170383 PMCID: PMC6392631 DOI: 10.1097/md.0000000000011903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Senile patients with LS complicated with DNM are rarely seen in clinical practice, and extensive cervical incision and drainage plus administration of effective antibiotics are the basis for treatment. Currently, the treatment controversy mainly has focused on whether mediastinal incision and drainage is necessary for patients with type I DNM, and whether anticoagulation therapy is required for jugular venous emboli and distant metastatic emboli induced by LS. PATIENT CONCERNS A female, 76 years old, developed pain of tonsil on right side 5 days ago, and felt that the pain aggravated complicated with dysphagia and swelling pain of neck on both sides since then. DIAGNOSES She was diagnosed with LS complicated with type I DNM. INTERVENTIONS Tazobactam and Piperacillin 4.5 q8h and Ornidazole 100 ml q6h ivgtt were administered empirically,and secondary extensive cervical incision and drainage was performed under general anesthesia, after which low molecular weight heparin 4250 U q12h SC was administered. G test was performed 3 days later, which showed (1,3)-β-D-glucan >1000 pg/ml. Bridging anticoagulation therapy, low molecular weight heparin 4250 U q12h SC, and Warfarin 2.5 mg qd po were given one week later. Low molecular weight heparin SC was discontinued and only Warfarin po was administered after treatment of bridging therapy for 3 days. OUTCOMES CT of head and neck was reexamined on post-admission d24 and revealed that neck infection was improved on both sides, jugular vein distension on right side was restored to normal, abscess and pneumatosis of superior mediastinum were improved, distension of pulmonary artery on both sides was normalized, WBC was 9.94×109/L, neutrophil count was 4.43×109/L, CRP level was 9.8mg/L, D-D level was 0.81mg/L, PCT level was 0.800ng/mL and G test suggested (1,3)-β-D-glucan pf 27.1 pg/mL. LESSONS Concomitant use of anticoagulants on the basis of repeated cervical incision and drainage + administration of effective antibiotics can obtain excellent therapeutic efficacy in the treatment of patient with LS complicated with type I DNM.
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11
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Unić J, Kovačić M, Jakovljević G, Batoš AT, Grmoja T, Hojsak I. Lemierre Syndrome in Adolescent with Active Ulcerative Colitis. Pediatr Gastroenterol Hepatol Nutr 2018; 21:214-217. [PMID: 29992123 PMCID: PMC6037802 DOI: 10.5223/pghn.2018.21.3.214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 10/06/2017] [Accepted: 10/08/2017] [Indexed: 11/14/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a well-recognized risk factor for thrombotic events in adults but data on children are scarce. In the great majority of adult patients, thrombotic events are usually deep vein thrombosis and pulmonary embolism. Other sites such as jugular veins are extremely rare. We present a case of Lemierre syndrome in an adolescent girl with active ulcerative colitis and discuss possible risk factors. This is the first reported case of severe Lemierre syndrome with thrombus extension to cranial veins in a patient with ulcerative colitis. Early recognition of Lemierre syndrome in patients who present with rapidly worsening symptoms of neck pain, fever and signs of pharyngitis is imperative because it increases a chance of favorable prognosis. It is important for pediatricians treating IBD patients not to underestimate possible thrombotic events in children with IBD. Recognition of additional risk factors is crucial for prompt diagnosis and adequate treatment.
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Affiliation(s)
- Josipa Unić
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Matea Kovačić
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Gordana Jakovljević
- Department of Oncology, Children's Hospital Zagreb, Zagreb, Croatia.,University J.J. Strossmayer School of Medicine, Osijek, Croatia
| | - Ana Tripalo Batoš
- Department of Pediatric Radiology, Children's Hospital Zagreb, Zagreb, Croatia
| | - Tonći Grmoja
- Department of Pediatric Radiology, Children's Hospital Zagreb, Zagreb, Croatia
| | - Iva Hojsak
- University of Zagreb School of Medicine, Zagreb, Croatia.,Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia.,University J.J. Strossmayer School of Medicine, Osijek, Croatia
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12
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Whittle T, Amiraraghi N, Sarkar B. Lemierre's syndrome: a rare cause of sepsis presenting with an absence of throat symptoms. BMJ Case Rep 2018; 2018:bcr-2017-224151. [PMID: 29705735 DOI: 10.1136/bcr-2017-224151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
A 16-year-old boy presented to hospital with a 6-day history of diarrhoea, vomiting and abdominal pain. During his admission he was found to be hypotensive, tachycardic and persistently feverish. Blood cultures taken on admission isolated Fusobacterium necrophorum CT scanning of his neck showed a non-occlusive thrombus of the right internal jugular vein and a small right parapharyngeal abscess. CT scans of the chest and abdomen revealed multiple pulmonary abscesses, bilateral pleural effusions and splenomegaly. Treatment consisted of an unfractionated heparin infusion and intravenous antibiotics. A right-sided intercostal drain was inserted for a complex right-sided empyema. He subsequently developed a left-sided pleural effusion which was treated with a video-assisted thoracoscopic surgery (VATS) pleurodesis procedure. His fever resolved after his VATS pleurodesis procedure 3 weeks after initial presentation. Clinically he made a slow recovery but now is improved after 6 weeks of intravenous antibiotics and was discharged home.
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Affiliation(s)
- Thomas Whittle
- Ear,Nose and Throat Surgery, NHS Ayrshire and Arran, Crosshouse Hospital, Ayr, UK
| | - Natasha Amiraraghi
- Ear,Nose and Throat Surgery, NHS Ayrshire and Arran, Crosshouse Hospital, Ayr, UK
| | - Bappa Sarkar
- Radiology, NHS Ayrshire and Arran, Crosshouse Hospital, Ayr, UK
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13
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Singh P, Adial A, Mann J, Iftikhar A. Lemierre's syndrome: cavitary lung disease caused by uncommon bacteria. BMJ Case Rep 2018; 2018:bcr-2018-224713. [PMID: 29669776 DOI: 10.1136/bcr-2018-224713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Parmjyot Singh
- Pulmonary/Critical Care Medicine, NewYork-Presbyterian Queens, Flushing, New York, USA
| | - Ajay Adial
- Pulmonary/Critical Care Medicine, NewYork-Presbyterian Queens, Flushing, New York, USA
| | - Jack Mann
- Pulmonary/Critical Care Medicine, NewYork-Presbyterian Queens, Flushing, New York, USA
| | - Asma Iftikhar
- Pulmonary/Critical Care Medicine, NewYork-Presbyterian Queens, Flushing, New York, USA.,Northwell Health System, Manhasset, New York, USA
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