A case report of Lemierre's Syndrome associated with dental sepsis

Lemierre's Syndrome Caused by Streptococcus anginosus Presenting as Postseptal Cellulitis in a Pediatric Patient

Lemierre's syndrome is an infrequent disease characterized by septic thrombosis of the internal jugular vein followed by pulmonary embolism generally occurring after upper respiratory and gastrointestinal tract infections. We present the case of a 15-year-old female patient with postseptal cellulitis and cervical abscess who developed pulmonary embolism and pleural effusion secondary to internal jugular vein thrombosis. Cultures were positive for Streptococcus anginosus, antibiotic treatment was established with satisfactory clinical outcome. High clinical suspicion is required for a diagnosis. The mainstay of treatment is a multidisciplinary approach based on two essential pillars: antibiotic therapy and surgical drainage. This is an important case because of the unusual presentation, the isolation of an infrequent pathogen, and the primary infection site (postseptal cellulitis), which are rare characteristics of this condition in the pediatric population.

Antibiotic and Anticoagulation Therapy in Lemierre's Syndrome: Case Report and Review

Lemierre's syndrome is a rare and fatal disease and is also known as the forgotten disease to describe the rarity of this syndrome in the antibiotic era. However, in the last 20 years, the incidence of this disease has been increasing. Authors report a case of Lemierre's syndrome with extensive venous thrombosis involving right internal jugular veins with extension to the sigmoid and lateral sinus and also review the literature on the use of anticoagulant therapy in Lemierre's syndrome. A computerized Medline study was carried out through the use of PUBMED: using the Medical Subject Headings terms 'Lemierre Syndrome/diagnosis' and words 'Lemierre's syndrome and anticoagulation'. From this, authors found 64 articles from 2002 to January 2018 with a total of 165 patients. The purpose of our review is to emphasize that antibiotic therapy should be started immediately, while anticoagulant therapy should be started in selected cases. Anticoagulation should be carried out in absence of any contraindication or presumed risk following clinical anticoagulation guidelines and only in patients with poor clinical response despite antibiotics therapy, predisposing thrombophilia and intracranial thrombosis.

Lemierre's syndrome: current perspectives on diagnosis and management

This is a systematic review of cases with Lemierre’s syndrome (LS) in the past 5 years. LS is characterized by sepsis often evolving after a sore throat or tonsillitis and then complicated by various septic emboli and thrombosis of the internal jugular vein. Symptoms include sepsis, pain, and/or swelling in the throat or neck, as well as respiratory symptoms. Laboratory findings show elevated infectious parameters and radiological findings show thrombosis of the internal jugular vein and emboli in the lungs or other organs. The syndrome is often associated with an infection with Fusobacterium necrophorum. We found a total of 137 cases of LS, of which 47 were infected with F. necrophorum and others with Staphylococcus and Streptococcus. Complications of this rare but severe disease included osteomyelitis, meningitis, and acute respiratory distress syndrome. Mortality was extremely high in the pre-antibiotic era but has diminished with the advent of antibiotics. This review showed a mortality rate of only 2% of which none of the cases involved fusobacteria. Duration of treatment varied; a 4–6-week course of carbapenem or piperacillin/tazobactam in combination with metronidazole was optimum. Other treatment options included anticoagulants in 46% of cases, which is unwarrantedly high, as to date, no evidence of the positive effects of anticoagulants in LS exists. Only two cases had ligation of the internal jugular vein performed. This review confirms the rare, but severe aspects of LS. Mortality from LS in this day and age appears to be low, however the syndrome is difficult to recognize, and still requires the full attention of the clinician.