Gutzeit A, Roos JE, Portocarrero-Fäh B, Reischauer C, Claas L, Gassmann K, Hergan K, Kos S, Rodic B, Winkler K, Karrer U, Sartoretti-Schefer S. Differential diagnosis of Lemierre's syndrome in a patient with acute paresis of the abducens and oculomotor nerves.
KOREAN JOURNAL OF OPHTHALMOLOGY 2013;
27:219-23. [PMID:
23730118 PMCID:
PMC3663068 DOI:
10.3341/kjo.2013.27.3.219]
[Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 01/18/2012] [Indexed: 11/23/2022] Open
Abstract
Lemierre's syndrome is characterized by anaerobic septicemia, internal jugular vein thrombosis, and septic emboli associated with infections of the head and neck. We describe an unusual and clinically confusing case of a young woman with an acute paresis of the abducens nerve and partial paresis of the right oculomotor nerve. After an extensive imaging diagnostic procedure, we also documented a peritonsillar abscess and various types of thromboses in intracranial and extracranial veins. Furthermore, we found brain and lung abscesses, which led us to establish the diagnosis of Lemierre's syndrome. Despite intensive anti-coagulation and antibiotic therapy, the patient developed a mycotic aneurysm in the right internal carotid artery directly adjacent to the previously thrombosed cavernous sinus. In summary, we were able to confirm that Lemierre's syndrome may occur in conjunction with uncharacteristic symptoms. Due to the sometimes confusing clinical symptoms as well as clinical and radiological specialties, we had to work on an interdisciplinary basis to minimize the delay prior to establishing the diagnosis and therapy.
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