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Mishima K, Aoki K, Shirai Y, Aritomo H, Iwasaka M, Katsura M, Tatsutani T, Ikeuchi H, Oryoji K, Mizuki S. Elderly onset atypical Lemierre's syndrome concurrent with a rheumatoid vasculitis sacral ulcer infection: a case report. BMC Infect Dis 2023; 23:145. [PMID: 36890459 PMCID: PMC9993631 DOI: 10.1186/s12879-023-08089-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 02/16/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Typical Lemierre's syndrome is usually secondary to an oropharyngeal infection. Recently, several cases following a primary infection site other than the oropharynx have been reported as atypical Lemierre's syndrome; although, these primary lesions are limited to the head and neck. This is the first case potentially sequential to infectious foci outside the head and neck. CASE PRESENTATION We describe an atypical Lemierre's syndrome in a 72-year-old woman with rheumatoid arthritis, which occurred during the treatment of Streptococcus anginosus bacteremia acquired from a sacral ulcer infection related to rheumatoid vasculitis. At first, the symptoms resolved after the initial administration of vancomycin for the bacteremia caused by methicillin-resistant Staphylococcus aureus and Streptococcus anginosus that entered via a sacral ulcer. On the 8th day, the patient developed a fever of 40 °C and unexpectedly required 10 L of oxygen due to rapid deterioration of oxygenation temporarily. Immediately contrast-enhanced computed tomography was performed to investigate systemic thrombosis including pulmonary embolism. Afterward, the newly formed thrombi at the right external jugular vein, bilateral internal jugular veins, and the right small saphenous vein were detected, and apixaban was started. On the 9th day, the patient again had an intermittent fever of 39.7 °C, and continuous Streptococcus anginosus bacteremia was revealed; subsequently, clindamycin was administered. On the 10th day, she developed a left hemothorax; consequently, apixaban was discontinued, and a thoracic drain was inserted. She repeatedly had an intermittent fever of 40.3 °C, and contrast-enhanced computed tomography detected an abscess formation at the left parotid gland, pterygoid muscle group, and masseter muscle. After Lemierre's syndrome was diagnosed in combination with the abovementioned jugular vein thrombus, clindamycin was replaced with meropenem, and vancomycin was increased. Swelling of the lower part of the left ear became prominent with delay and peaked at approximately the 16th day. The subsequent treatment course was favorable, and she was discharged on the 41st day. CONCLUSION Clinicians should consider Lemierre's syndrome as the differential diagnosis of internal jugular vein thrombosis occurring during sepsis, even though an antibiotic is administered or a primary infection site is anything besides the oropharynx.
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Affiliation(s)
- Koji Mishima
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan.
| | - Kazunobu Aoki
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan
| | - Yusuke Shirai
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan.,Department of Respiratory Medicine, Japanese Red Cross Ishinomaki Hospital, Miyagi Prefecture, Ishinomaki City, Japan
| | - Hiroshi Aritomo
- Department of Otorhinolaryngology, Matsuyama Red Cross Hospital, Matsuyama City, Ehime Prefecture, Japan
| | - Maiko Iwasaka
- Division of Dermatology, Matsuyama Red Cross Hospital, Matsuyama City, Ehime Prefecture, Japan
| | - Masakazu Katsura
- Department of Thoracic Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Ehime Prefecture, Japan
| | - Tomofumi Tatsutani
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan
| | - Hiroko Ikeuchi
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan
| | - Kensuke Oryoji
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan
| | - Shinichi Mizuki
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan
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Diagnosis and Management of Lemierre's Syndrome Presented with Multifocal Pneumonia and Cerebral Venous Sinus Thrombosis. Case Rep Infect Dis 2020; 2020:6396274. [PMID: 32231820 PMCID: PMC7085867 DOI: 10.1155/2020/6396274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/16/2020] [Indexed: 11/18/2022] Open
Abstract
A 27-year-old female patient initially presented with fever, myalgia, sore throat that progressed to multifocal pneumonia, and cerebral sinus venous thrombosis. A combination of upper respiratory symptoms with tooth infection, positive blood culture for Fusobacterium nucleatum, computed tomography (CT) chest finding of multifocal pneumonia, and magnetic resonance imaging (MRI) finding of internal jugular vein thrombosis (IJVT) and cerebral venous sinus thrombosis (CVST) suggested Lemierre syndrome. The patient was managed with fluids, antibiotics, and anticoagulants. The patient survived and discharged from the hospital. The patient's symptoms improved at 2 months of follow-up.
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Er C, Tey VHT, Kuthiah N, Aravamudan VM. A case of Lemierre-like Syndrome: internal jugular vein thrombosis secondary to Staphylococcus aureus sternoclavicular joint septic arthritis. Oxf Med Case Reports 2019; 2019:omz059. [PMID: 31293789 PMCID: PMC6611499 DOI: 10.1093/omcr/omz059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 11/23/2022] Open
Abstract
Lemierre syndrome is the internal jugular vein (IJV) suppurative thrombophlebitis, usually secondary to oropharyngeal infection. Staphylococcus aureus is an emerging responsible pathogen. We report a unique case of IJV thrombosis secondary to methicillin-susceptible S. aureus sternoclavicular joint septic arthritis. We review the existing literature on Lemierre syndrome: its various manifestations, causative pathogens, treatment and management.
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Affiliation(s)
- Chaozer Er
- Department of General Medicine, Woodlands Health Campus, Yishun Central, Tower E Level, Singapore
| | | | - Navin Kuthiah
- Department of General Medicine, Woodlands Health Campus, Yishun Central, Tower E Level, Singapore
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