Lemierre's syndrome caused by Klebsiella pneumoniae: A case report

Lemierre's Syndrome Due to Klebsiella pneumoniae Results in Pulmonary Abscess Complications in a Patient With Diabetes: A Rare Case Report

Background: Lemierre's syndrome (LS), first described by Andre Lemierre in the early 20th century, is a rare but potentially life-threatening condition typically caused by Fusobacterium necrophorum. However, recent literature has reported cases of LS caused by various other bacteria, including Klebsiella pneumoniae. In this report, we present a rare case of LS in a patient with diabetes caused by K. pneumoniae. Case Report: A 62-year-old Vietnamese male with a history of type 2 diabetes mellitus, presented with an 8-day history of progressive left neck swelling, fever, dysphagia, odynophagia, and reduced appetite. Despite initial antibiotic therapy, his condition deteriorated, leading to pulmonary abscesses and septic shock. Abscess content culture revealed K. pneumoniae. The patient required intubation, mechanical ventilation, and surgical drainage of the neck abscess. Treatment with meropenem, along with glycemic control, led to clinical improvement. The patient was subsequently extubated, achieved complete wound healing, and was discharged with normal biochemical parameters. Conclusion: This case highlights that LS can be caused by pathogens not initially outlined by Andre Lemierre, such as K. pneumoniae. Clinicians should consider a broader spectrum of causative organisms when there is a strong clinical suspicion of LS and adjust antimicrobial coverage accordingly. The association between K. pneumoniae-related LS and diabetes mellitus warrants further investigation, as current evidence suggests that diabetes may predispose patients to this particular pathogen.

Lemierre's syndrome associated-diabetic ketoacidosis in an elderly female: a case report

BACKGROUND

The co-occurrence of Lemierre's syndrome, primarily triggered by Fusobacterium necrophorum following oropharyngeal infection, with diabetic ketoacidosis (DKA) in diabetes mellitus (DM) patients, underscores a rare but life-threatening clinical scenario. Lemierre's syndrome induced DKA is extremely rare, with only one case report in adult and no case yet reported in elderly.

CASE PRESENTATION

We reported a case of a 69-year-old female who presented with DKA triggered by deep neck space infection (DNSI), leading to rapid clinical deterioration within 6 h that necessitated high flow nasal cannula (HFNC) and antibiotic administration. Laboratory findings included leukocytosis, elevated serum C-reactive protein, hyperglycemia, ketonemia, and severe metabolic acidosis. Culture of the fluid from a neck mass puncture drainage and blood were positive for Klebsiella pneumoniae. The patient was further complicated by thrombosis of the left internal jugular vein with extension to the sigmoid and a neck abscess surrounding the carotid artery sheath, consistent with Lemierre's syndrome. This condition was managed aggressively with fluid resuscitation, insulin therapy, surgical drainage, antibiotics, and anticoagulation led to a significant improvement in her condition. Following a 13-day hospitalization, there was significant clinical improvement, culminating in the patient's discharge.

CONCLUSIONS

The case highlights the need for greater awareness and understanding of the interrelated and mutually promoting conditions of DKA and Lemierre's syndrome among clinicians. Early recognition and treatment are crucial to prevent mortality in such complex cases.

Lemierre's syndrome: A rare complication of acute bacterial pharyngitis

Lemierre's syndrome is a rare clinical syndrome of septic thrombophlebitis following a bacterial oropharyngeal infection. Lemierre's syndrome can be difficult to recognise and has significant morbidity. We report the case of a young man with Lemierre's syndrome caused by Streptococcus pyogenes, who responded well to 2 weeks of beta-lactam therapy.

Contributions

This case report summarises the key presenting features of Lemierre's syndrome and provides a brief literature review considering the South African context.

Lemierre's Syndrome Caused by Klebsiella pneumoniae: A Case Report and Literature Review

Lemierre's syndrome is a rare condition that involves anaerobic sepsis following pharyngitis and is characterized by a high mortality rate. It often manifests as a septic embolism within the internal jugular vein due to oropharyngeal infections, leading to vein wall inflammation. Despite modern antibiotics, Lemierre's syndrome remains underdiagnosed and poses a significant threat. We report the case of a 43-year-old man who has alcoholic liver cirrhosis and diabetes mellitus. Symptoms included chest pain, back pain, and neck swelling, with Klebsiella pneumoniae leading to the diagnosis of K. pneumoniae-associated Lemierre's syndrome. Furthermore, K. pneumoniae-associated Lemierre's syndrome is linked to diabetes mellitus and the elderly population. Notably, it showed a tendency for distant metastases, particularly in the lungs and brain. Additionally, central nervous system and renal involvement were observed in a smaller subset of cases.

Lemierre's Syndrome: A Comeback Story

Lemierre's syndrome is a very rare and life-threatening complication of bacterial pharyngitis and tonsillitis. Often referred to as a 'forgotten disease', Lemierre's syndrome has seen a rise in cases over the years secondary to increased antibiotic resistance. With the potential for multiple organ failure secondary to widespread septic emboli, Lemierre's syndrome can no longer be forgotten. Prompt initiation of treatment is needed for better patient outcomes. We describe an unusual case of a young female without any significant past medical history who presented with left-sided pleuritic chest pain several days after experiencing a sore throat.