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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Dewdney CJ, Anderson JJ, Dewar S, Doubal F, Burgess FR, Subedi D, Lyall MJ. A case of Lemierre's syndrome causing panhypopituitarism, cavernous sinus thrombosis, ischaemic stroke and pulmonary embolism. J R Coll Physicians Edinb 2023; 53:258-262. [PMID: 37675957 DOI: 10.1177/14782715231198180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Infection is a rare cause of panhypopituitarism and has not been reported in the context of Lemierre's syndrome. We present the case of a previously well 19-year-old man, who presented acutely unwell with meningitis and sepsis. Fusobacterium necrophorum was isolated from peripheral blood cultures and identified on cerebrospinal fluid with 16S rDNA Polymerase Chain Reaction (PCR). Imaging demonstrated internal jugular vein thrombosis with subsequent cavernous venous sinus thrombosis. Pituitary function tests were suggestive of panhypopituitarism. The patient was diagnosed with Lemierre's syndrome complicated by meningitis, cavernous sinus thrombosis, base of skull osteomyelitis, ischaemic stroke and panhypopituitarism. He was treated with 13 weeks of intravenous antibiotics followed by 3 weeks of oral amoxicillin, and anticoagulated with dalteparin then apixaban. His panhypopituitarism was managed with hydrocortisone, levothyroxine and desmopressin.
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Affiliation(s)
| | | | - Simon Dewar
- Department of Medical Microbiology, NHS Lothian, Edinburgh, UK
| | - Fergus Doubal
- Centre for Clinical Brain Sciences, Edinburgh Neuroscience, Edinburgh, UK
| | | | - Deepak Subedi
- Department of Radiology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Marcus J Lyall
- Edinburgh Centre for Endocrinology and Diabetes, NHS Lothian, Edinburgh, UK
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3
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Tiwari A. Lemierre's Syndrome in the 21st Century: A Literature Review. Cureus 2023; 15:e43685. [PMID: 37724228 PMCID: PMC10505273 DOI: 10.7759/cureus.43685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/20/2023] Open
Abstract
Lemierre's syndrome is a rare, life-threatening complication of an acute oropharyngeal infection. It is generally characterised by pharyngitis secondary to Fusobacterium necrophorum, causing thrombophlebitis of the internal jugular vein and sepsis, with subsequent formation of septic emboli that can rapidly spread to different organ sites. The condition is associated with high mortality if treatment with antibiotics is delayed, and recent evidence suggests that patients are at significant risk of in-hospital morbidity and long-term neurological sequelae. Although it is agreed that antibiotics are the mainstay of treatment, there is currently no consensus on the use of anticoagulation in the condition. This review article aims to summarise our current understanding of Lemierre's syndrome with regard to its definition, epidemiology, microbiology, presentation, diagnosis, and treatment.
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Affiliation(s)
- Abhinav Tiwari
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
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Craven P, End B, Griffin P. Emergency Department Point-of-care Ultrasound Identification of Suspected Lemierre's Syndrome: A Case Report. Clin Pract Cases Emerg Med 2023; 7:172-174. [PMID: 37595317 PMCID: PMC10438937 DOI: 10.5811/cpcem.1245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 08/20/2023] Open
Abstract
INTRODUCTION Lemierre's syndrome is septic thrombophlebitis of the internal jugular vein, most commonly associated with head and neck infections. While central catheters are associated with venous thromboembolism and catheter-associated bacterial infections, cases of Lemierre's syndrome caused by central catheters are extraordinarily rare. CASE REPORT We detail a case of Lemierre's syndrome resulting from a peripherally inserted central catheter in a pregnant female patient. Diagnosis of this rare and potentially life-threatening disease process was expedited using point-of-care ultrasound. CONCLUSION Diagnosis of rare but potentially life- or limb-threatening pathologies is paramount to the successful practice of emergency medicine. Identifying these rare disease processes requires a high index of suspicion and a work-up strategy that includes consideration of medical history in combination with lab and imaging findings to determine appropriate interventions.
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Affiliation(s)
- Paul Craven
- West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia
| | - Bradley End
- West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia
| | - Peter Griffin
- West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia
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Jena N, Yella PR, Chandramohan D. Lemierre's Syndrome Due to Streptococcus anginosus: A Case Report and Review of the Literature. Cureus 2023; 15:e44311. [PMID: 37779762 PMCID: PMC10535718 DOI: 10.7759/cureus.44311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Lemierre's syndrome, also known as anaerobic post-anginal septicemia, necrobacillosis, and the "forgotten disease," is a rare manifestation. It is often presented with sepsis, sore throat, fever, neck pain, internal jugular vein thrombophlebitis/thrombosis, and septic emboli. The bacteria that are usually associated with the disease are Fusobacterium species, but it is also associated with Staphylococcus, Streptococcus, and other bacterial species. The diagnosis of Lemierre's syndrome is made based on evidence of septic thrombophlebitis, preceding oropharyngeal infection, and positive culture. Treatment usually consists of antibiotics directed toward the causative organism. The use of anticoagulation, although controversial, is shown to be beneficial by several studies. We describe a middle-aged patient who presented with a sore throat, neck pain, and dysphagia. Imaging of the neck and chest revealed right jugular thrombosis along with septic emboli in the lungs. The culture of the blood and pus drained from the peritonsillar abscess grew Streptococcus anginosus. In this study, we have illustrated the effective management of Lemierre's syndrome with antibiotics, anticoagulants, and needle aspiration of abscess.
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Affiliation(s)
- Nihar Jena
- Cardiovascular Medicine, Saint Joseph Mercy Oakland, Pontiac, USA
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Sanivarapu RR, Rajamreddy RS, Nalla S, Shaik Masthan S, Mangu G. Lemierre's Syndrome in the External Jugular Vein Precipitated by COVID-19 Infection. Cureus 2023; 15:e34512. [PMID: 36874340 PMCID: PMC9984202 DOI: 10.7759/cureus.34512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Lemierre's syndrome is a condition when an oropharyngeal infection, typically from Fusobacterium necrophorum, causes thrombophlebitis of the internal jugular vein. There have been few case reports of Lemierre's syndrome affecting the external jugular vein, but to our knowledge, this is the first case report where COVID-19 infection is the prime suspect for causing this syndrome. SARS-CoV-2 infection, known to cause hypercoagulability and immunosuppression, increases the risk of deep venous thrombosis and secondary infections. We report a case of a young male with no known risk factors who developed Lemierre's syndrome as a complication of COVID infection.
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Affiliation(s)
- Raghavendra R Sanivarapu
- Pulmonary and Critical Care Medicine, Texas Tech University Health Sciences Center, Odessa, USA.,Pulmonary and Critical Care Medicine, Nassau University Medical Center, East Meadow, USA
| | - Ramya Sruthi Rajamreddy
- Internal Medicine, People's Education Society Institute of Medical Sciences and Research (PESIMSR), Kuppam, IND
| | - Swetha Nalla
- Internal Medicine, Mamata Medical College, Khammam, IND
| | | | - Goutami Mangu
- Internal Medicine, Texas Tech University Health Sciences Center, Odessa, USA
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7
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Thapa G, Jayal A, Sikazwe E, Perry T, Mohammed Al Balushi A, Livingstone P. A genome-led study on the pathogenesis of Fusobacterium necrophorum infections. Gene 2022; 840:146770. [PMID: 35905848 DOI: 10.1016/j.gene.2022.146770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/27/2022] [Accepted: 07/24/2022] [Indexed: 11/04/2022]
Abstract
Fusobacterium necrophorum causes a range of mild to life threatening infections and there is uncertainty in terms of diagnosis and treatment due to the lack of knowledge on their pathogenic mechanisms. This study characterised genomes of F. necrophorum to compare their virulence factors and investigate potential infection markers. 27 isolates of F. necrophorum from patients with pharyngotonsillitis were subjected to whole genome sequencing and compared with 42 genomes published in the NCBI database. Phylogenomics, pangemome, pan-GWAS and virulome were analysed to study strain variations with reference to virulence factors. Core genome based phylogenomic tree exhibited three clades of which Clade A belonged to F. necrophorum subsp necrophorum, clades B and C were F. necrophorum subsp funduliforme. Pan-GWAS and Pan-Virulome suggest some marker genes associated with clinical sources of isolation that needs further validation. Our study highlights some interesting features of the pathogenesis of F. necrophorum infections. Although the animal isolate genomes had some marker genes, the genomes of human isolates did not exhibit clear correlation to their clinical sources of isolation. This prompts to think of other mechanisms such as co-infections or host factors that can be involved in the pathogenesis.
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Affiliation(s)
- Gary Thapa
- Public Health Wales Microbiology Aberystwyth, Bronglais General Hospital, Aberystwyth
| | - Ambikesh Jayal
- School of Information Systems and Technology, University of Canberra, Australia
| | - Elvis Sikazwe
- School of Sports and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Thomas Perry
- School of Sports and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Ali Mohammed Al Balushi
- School of Sports and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Paul Livingstone
- School of Sports and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom.
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8
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Mohiuddin Z, Manes T, Emerson A. Fusobacterium necrophorum Bacteremia With Evidence of Cavitary Pulmonary Lesion. Cureus 2021; 13:e19537. [PMID: 34934555 PMCID: PMC8668149 DOI: 10.7759/cureus.19537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2021] [Indexed: 11/05/2022] Open
Abstract
Fusobacterium necrophorum (F. necrophorum) is a gram-negative anaerobic bacterium and a known etiologic agent in Lemierre's syndrome. This rare disease commonly presents with persistent sore throat and dysphagia, which can spread to involve the internal jugular vein. Presented in this report is an interesting case of a patient who presented with a progressively worsening sore throat, dysphagia, and productive cough on admission. Blood cultures were positive for F. necrophorum and computed tomography angiogram (CTA) of the chest detected cavitation in the left lower lobe and a large consolidation within the right lower lobe without evidence of a vascular defect. CT of the neck with IV contrast demonstrated no findings of abnormal vascular structures. This patient was diagnosed with pneumonia secondary to F. necrophorum bacteremia and treated successfully with antibiotics and was discharged home. Clinical suspicion is warranted in patients with worsening symptoms of sore throat and dysphagia, as this rare syndrome may be present.
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Affiliation(s)
- Zain Mohiuddin
- Internal Medicine, Western Reserve Hospital, Cuyahoga Falls, USA
| | - Taylor Manes
- Internal Medicine, A.T. Still University - Kirksville College of Osteopathic Medicine, Kirksville, USA
| | - Andrew Emerson
- Family Medicine, Western Reserve Hospital, Cuyahoga Falls, USA
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Gohal SO, Alsubhi IM, Alharbi EA, Alkhalaf HE, Alnefaie BH, Althomali RA, Hasan BA, Alsadi MA, Alamri AH, Alharbi AA, Almanea MY, Almarshood FS, Almoallem SA, Albogami AF, Al-Hawaj F. Lemierre's Syndrome: A Case of Life-Threatening Infection From Family Medicine Practice. Cureus 2021; 13:e20684. [PMID: 35106224 PMCID: PMC8785805 DOI: 10.7759/cureus.20684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2021] [Indexed: 11/17/2022] Open
Abstract
The use of antibiotic therapy has led to a major transformation in medicine with a substantial reduction in mortality. Due to the adverse effects associated with inappropriate antibiotic use, antibiotic stewardship interventions have been promoted to improve antibiotic prescription. However, delayed antibiotic therapy, when clinically needed, may result in increased morbidity. Here, we report the case of a previously healthy young man with an untreated acute upper respiratory infection for two weeks, who presented with headache and fever. Physical examination suggested meningitis as evident by neck stiffness and positive Kernig sign. Purulent tonsilitis was also noted. Laboratory findings showed leukocytosis and elevated inflammatory markers. The patient underwent a computed tomography scan to rule out space-occupying lesions prior to lumbar puncture. The scan revealed thrombophlebitis of the left internal jugular vein that extended to the dural venous sinuses. Magnetic resonance imaging confirmed the intracranial dissemination of the disease. Such findings conferred the diagnosis of Lemierre's syndrome. The patient was admitted to the intensive care unit where he received systemic anticoagulation and prolonged intravenous antibiotics. He developed a good response and was discharged with no residual deficits after six weeks of hospitalization. Lemierre's syndrome is a serious infection that develops after a pharyngeal infection. Considering the high mortality rate of untreated Lemierre's syndrome, physicians should keep a high index of suspicion for this condition when they encounter a patient with upper respiratory tract infection with clinical or radiological findings consistent with internal jugular thrombophlebitis.
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Affiliation(s)
- Sultan O Gohal
- College of Medicine, Batterjee Medical College, Jeddah, SAU
| | - Ishtiyaq M Alsubhi
- Department of General Practice, King Salman Specialist Hospital, Hail, SAU
| | - Essa A Alharbi
- College of Medicine, Northern Border University, Arar, SAU
| | | | - Bandar H Alnefaie
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | - Bayan A Hasan
- College of Medicine, Arabian Gulf University, Manama, BHR
| | - Mada A Alsadi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Assaf H Alamri
- College of Medicine, Jordan University of Science and Technology, Irbid, JOR
| | | | | | | | | | | | - Faisal Al-Hawaj
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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10
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Jaber TM, Saini V, Ogbebor O, Dumont T, Balaan M, Lega M, Cheema T. Lemierre's Syndrome: A Case Series. Cureus 2021; 13:e18436. [PMID: 34737904 PMCID: PMC8559581 DOI: 10.7759/cureus.18436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 12/02/2022] Open
Abstract
Lemierre’s syndrome (LS) is a potentially fatal complication of oropharyngeal infection, resulting in contiguous suppurative thrombosis of the internal jugular vein (IJV) and septic emboli. It is most commonly associated with Fusobacterium necrophorum (F. necrophorum), though other pathogens have also been implicated in its pathogenesis. The incidence of LS had so significantly decreased that it was referred to as "the forgotten disease." However, cases of LS have shown a resurgence, which may be partly attributed to an overreliance on a negative group A beta-hemolytic streptococcal rapid antigen detection test (RADT), commonly referred to as "rapid strep test." Clinicians must maintain a very high index of suspicion for LS in patients with persistent sequelae from tonsillopharyngitis who have a negative RADT.
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Affiliation(s)
- Tariq M Jaber
- Infectious Disease & Critical Care, Allegheny Health Network, Pittsburgh, USA
| | - Vikram Saini
- Infectious Disease & Critical Care, Allegheny Health Network, Pittsburgh, USA
| | - Osakpolor Ogbebor
- Internal Medicine/Infectious Disease & Critical Care, Allegheny Health Network, Pittsburgh, USA
| | - Tiffany Dumont
- Pulmonary and Critical Care Medicine, Allegheny Health Network, Pittsburgh, USA
| | - Marvin Balaan
- Pulmonary and Critical Care Medicine, Allegheny General Hospital, Pittsburgh, USA
| | - Mark Lega
- Division of Pulmonary and Critical Care Medicine, Allegheny General Hospital, Pittsburgh, USA
| | - Tariq Cheema
- Pulmonary and Critical Care Medicine, Allegheny Health Network, Pittsburgh, USA
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Costa F, Matos Bela M, Ferreira I, Cidade Rodrigues C, América Silva A. Not All Pulmonary Densifications Are COVID-19: A Case Report About Lemierre's Syndrome. Cureus 2021; 13:e15984. [PMID: 34336475 PMCID: PMC8318612 DOI: 10.7759/cureus.15984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 11/05/2022] Open
Abstract
Lemierre's syndrome is a rare and a life-threatening disease characterized by anaerobic bacteraemia associated with thrombosis of the internal jugular vein. Odynophagia, otalgia, odontalgia, dyspnoea, cough and fever are the most frequent manifestations. We describe a case of a 37-year-old woman who was admitted to the emergency room due to fever, odynophagia, dyspnoea, myalgia, and pleuritic chest pain. She had hypoxaemia and increased systemic inflammatory markers. The chest CT showed parenchymal densification compatible with severe acute respiratory syndrome coronavirus infection, although all three polymerase chain reaction testing were negative. The neck CT showed occlusion of the left cervical internal jugular vein. She was treated with antibiotics and was discharged. With the reported clinical case the authors intend to clarify the importance of differential diagnosis and the diagnosis of other infectious respiratory conditions at the time of a global pandemic.
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Affiliation(s)
- Fátima Costa
- Internal Medicine, Centro Hospitalar Tâmega e Sousa, Penafiel, PRT
| | | | - Inês Ferreira
- Internal Medicine, Centro Hospitalar Tâmega e Sousa, Penafiel, PRT
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12
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Aggarwal SK, Nath A, Singh R, Keshri A. Lemierre's Syndrome presenting with neurological and pulmonary symptoms: Case report and review of the literature. Ann Indian Acad Neurol 2013; 16:259-63. [PMID: 23956578 PMCID: PMC3724088 DOI: 10.4103/0972-2327.112489] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 01/26/2012] [Accepted: 02/19/2012] [Indexed: 11/22/2022] Open
Abstract
Lemierre’s Syndrome (LS) is a potentially life-threatening condition, characterized by clinical or radiologic evidence of internal jugular vein thrombosis following an oropharyngeal infection, most commonly by Fusobacterium necrophorum. A high index of suspicion and early recognition is important for successful management and to prevent systemic complications like multiorgan failure with extremely high morbidity, prolonged hospitalization and, not uncommonly, death. We are reporting a rare case of LS that was complicated with internal jugular vein and cavernous sinus thrombosis along with lung metastatic lesions, which was diagnosed and treated at our institute.
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Affiliation(s)
- Sushil Kumar Aggarwal
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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13
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Abstract
A sore throat, which is most commonly viewed as a minor ailment, can be a manifestation of a life-threatening disorder known as Lemierre's syndrome caused by Fusobacterium necrophorum. We report a new case of Lemierre's syndrome that occurred in an otherwise healthy 18-year-old woman, who initially presented with fever and sore throat. The diagnosis was not made until a week later when blood cultures became available. This syndrome should be suspected until proven otherwise in any patient with signs of pharyngitis, a painful swollen neck, and pulmonary symptoms. By presenting this curable, but potentially life-threatening case of Lemierre's syndrome, we hope to increase the awareness of the early clinical manifestations of Lemierre's syndrome and to emphasize the importance of careful physical examination with special attention to the neck. Clinicians should be aware that exclusion of streptococcal infection in a patient with severe tonsillar infection does not exclude a bacterial cause.
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Affiliation(s)
- Hai-Yan Li
- Department of Medicine, University of Tennessee, College of Medicine, Chattanooga, TN, USA.
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