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Burgdorf E, Jensen J, Grimm P, von Huth S. Atypical presentation of Lemierre's syndrome caused by penicillin-susceptible Staphylococcus aureus in a patient with chronic stomatitis and COVID-19. BMJ Case Rep 2024; 17:e258776. [PMID: 38569736 PMCID: PMC10989154 DOI: 10.1136/bcr-2023-258776] [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: 04/05/2024] Open
Abstract
A healthy man in his late 20s was admitted to the emergency department due to a flare-up in his severe chronic stomatitis, along with flu-like symptoms. CXR showed multiple bilateral consolidations and subsequent CT revealed thrombosis of the left facial and internal jugular vein, together with septic embolism in both lungs. Blood cultures showed penicillin-susceptible Staphylococcus aureus The patient was diagnosed with Lemierre's syndrome, despite atypical bacteria and clinical presentation. During hospitalisation, he developed pulmonary empyema as a complication and was admitted for 4 weeks. During hospitalisation and after discharge, the patient was examined for multiple rheumatic, immunological and dermatological diseases, but no underlying cause for Lemierre's syndrome has been found. We present this case due to the rarity of its nature, with atypical clinical presentation and pathogen for Lemierre's syndrome, but with classic radiological findings.
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Affiliation(s)
- Emma Burgdorf
- Department of Radiology, Odense Universitetshospital, Odense, Syddanmark, Denmark
| | - Janni Jensen
- Department of Radiology, Odense Universitetshospital, Odense, Syddanmark, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Peter Grimm
- Department of Radiology, Odense Universitetshospital, Odense, Syddanmark, Denmark
| | - Sebastian von Huth
- Department of Infectious Diseases, Odense Universitetshospital, Odense, Syddanmark, Denmark
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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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Miura T, Fukuda H, Kawada H, Kaga T, Matsuo M, Sakai T, Yoshida S, Okada H, Ogura S, Tetsuka N. Delayed diagnosis of Lemierre's syndrome in a patient with severe coronavirus disease 2019: importance of comprehensive oral and neck examination - a case report. BMC Infect Dis 2023; 23:768. [PMID: 37936077 PMCID: PMC10629146 DOI: 10.1186/s12879-023-08755-2] [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] [Received: 06/15/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Given the widespread prevalence of the coronavirus disease 2019 (COVID-19), oral and neck examinations tend to be avoided in patients with suspected or confirmed COVID-19. This might delay the diagnosis of conditions such as Lemierre's syndrome, which involves symptoms resembling COVID-19-related throat manifestations. CASE PRESENTATION A 24-year-old man without any underlying conditions was diagnosed with COVID-19 7 days before presentation. He was admitted to another hospital 1 day before presentation with severe COVID-19 and suspected bacterial pneumonia; accordingly, he was started on treatment with remdesivir and meropenem. Owing to bacteremic complications, the patient was transferred to our hospital for intensive care. On the sixth day, the patient experienced hemoptysis; further, a computed tomography (CT) scan revealed new pulmonary artery pseudoaneurysms. Successful embolization was performed to achieve hemostasis. In blood cultures conducted at the previous hospital, Fusobacterium nucleatum was isolated, suggesting a cervical origin of the infection. A neck CT scan confirmed a peritonsillar abscess and left internal jugular vein thrombus; accordingly, he was diagnosed with Lemierre's syndrome. The treatment was switched to ampicillin/sulbactam, based on the drug susceptibility results. After 6 weeks of treatment, the patient completely recovered without complications. CONCLUSION This case highlights the significance of thorough oral and neck examinations in patients with suspected or diagnosed COVID-19 for the detection of throat and neck symptoms caused by other conditions.
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Affiliation(s)
- Tomotaka Miura
- Advanced Critical Care Center, Gifu University Hospital, Gifu, Japan
- Department of Infection Control, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-Shi, Gifu, 501-1194, Japan
| | - Hirotsugu Fukuda
- Advanced Critical Care Center, Gifu University Hospital, Gifu, Japan
| | | | - Tetsuro Kaga
- Department of Radiology, Gifu University, Gifu, Japan
| | | | - Tsutomu Sakai
- Gastroenterology, Hashima City Hospital, Gifu, Japan
| | - Shozo Yoshida
- Advanced Critical Care Center, Gifu University Hospital, Gifu, Japan
| | - Hideshi Okada
- Advanced Critical Care Center, Gifu University Hospital, Gifu, Japan
| | - Shinji Ogura
- Advanced Critical Care Center, Gifu University Hospital, Gifu, Japan
| | - Nobuyuki Tetsuka
- Department of Infection Control, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-Shi, Gifu, 501-1194, Japan.
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Pandey S, Rayapureddy AK, Manvar K, Edara S, Boddu G, Thakur A, Jaswani V. Septic thrombophlebitis of portal and splenic vein secondary to Fusobacterium nucleatum: A case report of an abdominal variant of lemierre syndrome. Medicine (Baltimore) 2023; 102:e35622. [PMID: 37832062 PMCID: PMC10578700 DOI: 10.1097/md.0000000000035622] [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: 07/12/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
RATIONALE Septic thrombophlebitis of the internal jugular vein also known as Lemierre syndrome occurs secondary to an oropharyngeal infection often leading to septic embolisms to distant sites. Anaerobic gram-negative bacillus, Fusobacterium nucleatum and Fusobacterium necrophorum are commonly isolated organisms. Fusobacterium species has also been reported to complicate an intra-abdominal infection leading to septic thrombophlebitis of portal vein also known as pylephlebitis or abdominal variant of lemierre syndrome. PATIENT CONCERNS The patient was a middle-aged female patient with chief complaints of abdominal discomfort, intermittent fever and vomiting for one month. DIAGNOSES The final diagnosis was septic thrombophlebitis of portal and splenic vein secondary to Fusobacterium nucleatum. INTERVENTIONS Patient was managed with broad spectrum intravenous antibiotics with coverage against gram-negative bacilli, anaerobes, and aerobic streptococcus species with therapeutic anticoagulation. OUTCOMES Patient gradually improved and was discharged on oral apixaban. She was instructed to follow up with gastrointestinal specialist upon discharge in anticipation of the need for liver transplant in future. LESSONS Due to its high mortality and associated long term disease morbidity, clinicians should always strive towards early diagnosis and treatment of the condition with involvement of multidisciplinary teams.
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Affiliation(s)
- Sagar Pandey
- Department of Internal Medicine, One Brooklyn Health- Interfaith Medical Center, NY
| | | | - Kapilkumar Manvar
- Department of Hematology and Medical Oncology, One Brooklyn Health- Brookdale University Hospital Medical Center, NY
| | - Sushma Edara
- Department of Internal Medicine, One Brooklyn Health- Interfaith Medical Center, NY
| | - Gouthami Boddu
- Department of Internal Medicine, One Brooklyn Health- Interfaith Medical Center, NY
| | - Ajit Thakur
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Vijay Jaswani
- Department of Radiology, One Brooklyn Health- Interfaith Medical Center, NY
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5
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Bedan M, Gloksin W, Hagen TL. Lemierre's syndrome-A diagnostic challenge. Diagn Microbiol Infect Dis 2023; 107:116023. [PMID: 37499606 DOI: 10.1016/j.diagmicrobio.2023.116023] [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] [Received: 03/13/2023] [Revised: 07/06/2023] [Accepted: 07/09/2023] [Indexed: 07/29/2023]
Abstract
In this case report, we present a young man with Lemierre's syndrome, which is a potentially fatal condition most commonly caused by the bacterium Fusobacterium necrophorum. When Lemierre's syndrome is suspected, it is important to consider X-ray, ultrasound, and CT scan, as they can bring tremendous diagnostic value.
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Affiliation(s)
- Martin Bedan
- Aalborg University Hospital, Thisted Hospital, Thisted, Denmark.
| | - Witold Gloksin
- Aalborg University Hospital, Thisted Hospital, Thisted, Denmark.
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Constans S, Bosshard T, Petignat PA, Le Peillet D. Atypical involvement of the thyro-linguo-facial vein in Lemierre syndrome. BMJ Case Rep 2022; 15:e251722. [PMID: 36379635 PMCID: PMC9667992 DOI: 10.1136/bcr-2022-251722] [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: 11/16/2022] Open
Abstract
Fusobacterium necrophorum is a Gram-negative anaerobic bacterium that can lead to severe infection in young patients even without immunodeficiency. Due to the length of time for isolation and speciation of this Gram-negative bacillus (typically 5-8 days), and its potential mortality, broad-spectrum antibiotic therapy should be started without delay. With a cervical thrombosis, even on an unusual site and with a standard condition such as tonsillitis, Lemierre syndrome should be considered. We report a case of Lemierre syndrome in a previously healthy young woman.
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Affiliation(s)
- Sophie Constans
- Internal Medicine, Valais Hospital, Sion, Valais, Switzerland
| | - Thomas Bosshard
- Internal Medicine, Valais Hospital, Sion, Valais, Switzerland
| | - Pierre-Auguste Petignat
- Internal Medicine, Hôpital de Sion Centre Hospitalier du Valais Romand, Sion, Valais, Switzerland
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7
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King JP, Matthews L, Ashai S. Atypical presentation of Lemierre syndrome in a young healthy man with acute jaundice. BMJ Case Rep 2022; 15:e249824. [PMID: 36129352 PMCID: PMC9438057 DOI: 10.1136/bcr-2022-249824] [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: 11/04/2022] Open
Abstract
This report presents a case of Lemierre syndrome caused by Fusobacterium necrophorum in a healthy young adult who presented atypically with shortness of breath and jaundice but no clinical or diagnostic evidence of thrombophlebitis. Due to this unusual presentation with jaundice, diagnosis was challenging and delayed. However, the patient was successfully initiated on a prolonged course of intravenous antibiotics; he required a period in the intensive care unit and was discharged without significant complications. This report aims to raise awareness of the diagnosis and treatment of this rare condition and to highlight both common and unusual presentations of the syndrome.
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Affiliation(s)
| | - Lauren Matthews
- Jack Steinberg Critical Care Unit, King's College Hospital, London, UK
| | - Shanze Ashai
- Jack Steinberg Critical Care Unit, King's College Hospital, London, UK
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8
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Affiliation(s)
- Michael J Litt
- From the Department of Medicine, Brigham and Women's Hospital, Boston
| | - Mary W Montgomery
- From the Department of Medicine, Brigham and Women's Hospital, Boston
| | - Kirstin M Small
- From the Department of Medicine, Brigham and Women's Hospital, Boston
| | - Amy L Miller
- From the Department of Medicine, Brigham and Women's Hospital, Boston
| | - Joseph Loscalzo
- From the Department of Medicine, Brigham and Women's Hospital, Boston
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9
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Liu A, Taylor J, Slavin M, Tong S. Severe case of Lemierre syndrome with multiple neurological and ophthalmological sequelae. BMJ Case Rep 2021; 14:e244669. [PMID: 34426431 PMCID: PMC8383858 DOI: 10.1136/bcr-2021-244669] [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] [Accepted: 07/31/2021] [Indexed: 11/03/2022] Open
Abstract
A 56-year-old man was admitted to intensive care with septic shock, multiple facial abscesses and thrombophlebitis of the right internal jugular vein with extensive intracranial extension. A diagnosis of Lemierre syndrome due to Streptococcus anginosus was made and treatment initiated with high-dose ceftriaxone and metronidazole, along with surgical debridement. His admission was complicated by raised intraocular pressures and visual loss requiring bilateral canthotomies. Despite therapeutic anticoagulation with enoxaparin, he also developed an ischaemic basal ganglia infarct. After a prolonged and complex hospital stay, the patient was later readmitted with an intracerebral abscess requiring surgical excision and a second course of antibiotics. This case highlights the value of early recognition of this rare but potentially life-threatening condition, considerations around anticoagulation and antibiotic decisions, and the importance of close multidisciplinary follow-up even after discharge from hospital.
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Affiliation(s)
- Alice Liu
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jemma Taylor
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Monica Slavin
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Infectious Diseases & Infection Prevention Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Steven Tong
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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10
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Abstract
PURPOSE To report an intraocular Jarisch-Herxheimer reaction induced by Lemierre syndrome antibiotherapy. METHODS Case report. RESULTS A 43-year-old-man presented with an acute onset of bilateral blurred vision few days after intravenous antibiotic administration for Lemierre syndrome. Best-corrected visual acuity was 20/32 in both eyes. Examination revealed bilateral cystoid macular edema and peripheral retinal vasculitis, persisting despite Lemierre syndrome recovery with antibiotics. Intravitreal injection of ranibizumab 0.5 mg (0.05 mL) was performed in both eyes. After 1 month, cystoid macular edema and retinal vasculitis were totally resolved, and best-corrected visual acuity increased to 20/20 in both eyes. The paradoxical worsening of the patient's best-corrected visual acuity after initiating antibiotherapy evokes a Jarisch-Herxheimer reaction. The result of this single intravitreal injection of ranibizumab was sustained; best-corrected visual acuity remained unchanged (20/20 in both eyes), and no recurrence of cystoid macular edema or retinal vasculitis was found after 4-year follow-up. CONCLUSION To the best of our knowledge, this is the first reported case of an isolated intraocular Jarisch-Herxheimer reaction induced by Lemierre syndrome antibiotherapy and successfully treated with a single intravitreal injection of ranibizumab.
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Affiliation(s)
- Prithvi Ramtohul
- Department of Ophthalmology, Centre Hospitalier Henri Duffaut d'Avignon, Avignon, France
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11
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McCleane A, Hunter M, Johnston PC, Trimble M, Malloy J, Wallace IR. A rare, but life-threatening sore throat: A case of Lemierre's syndrome. Acute Med 2021; 20:78-82. [PMID: 33749697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We present the case of a previously healthy, immunocompetent male with Lemierre's Syndrome. He presented with headache, sore throat and pyrexia. Initial blood tests revealed raised inflammatory markers and electrolyte abnormalities. Blood cultured Fusobacterium necrophorum. He developed respiratory distress and imaging confirmed lung abscess and empyema due to septic emboli. He required surgical drainage and a prolonged course of antibiotics. This case highlights the rare, but life-threatening condition of Lemierre's Syndrome. We discuss the importance of prompt recognition and early antibiotic therapy.
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Affiliation(s)
- A McCleane
- MB, BCh, BAO, MRCP, Acute Medicine Unit, Wards 7B and 7C, Royal Victoria Hospital, Belfast
| | - M Hunter
- MB, BCh, BAO, FRCP, Department of Infectious Diseases, Royal Victoria Hospital, Belfast
| | - P C Johnston
- MB, BCh, BAO, FRCP, MD, Acute Medicine Unit, Wards 7B and 7C, Royal Victoria Hospital, Belfast
| | - M Trimble
- MB, ChB, MSc, MMSc, MA, FRCP, FAcadMEd, Department of Infectious Diseases, Royal Victoria Hospital, Belfast
| | - J Malloy
- MB, BCh, BAO, FRCR, Department of Radiology, Imaging Centre, Royal Victoria Hospital, Belfast
| | - I R Wallace
- MB, BCh, BAO, FRCP, PhD, Acute Medicine Unit, Wards 7B and 7C, Royal Victoria Hospital, Belfast
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12
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Bellazreg F, Ben Haj Ali E, Ben Lasfar N, Mama N, Hachfi W, Letaief A. Lemierre syndrome, a rare complication of otitis media. J Med Vasc 2020; 45:168-170. [PMID: 32402432 DOI: 10.1016/j.jdmv.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/15/2020] [Indexed: 06/11/2023]
Affiliation(s)
- F Bellazreg
- Department of Infectious Diseases, Farhat-Hached University hospital, 4000 Sousse, Tunisia; University of Sousse, Faculté de Médecine Ibn-Al-Jazzar, 4000 Sousse, Tunisia.
| | - E Ben Haj Ali
- Department of Internal Medicine, Farhat-Hached University hospital, 4000 Sousse, Tunisia
| | - N Ben Lasfar
- Department of Infectious Diseases, Farhat-Hached University hospital, 4000 Sousse, Tunisia; University of Sousse, Faculté de Médecine Ibn-Al-Jazzar, 4000 Sousse, Tunisia
| | - N Mama
- Department of Radiology, Sahloul University hospital, 4000 Sousse, Tunisia; University of Sousse, Faculté de Médecine Ibn-Al-Jazzar, 4000 Sousse, Tunisia
| | - W Hachfi
- Department of Infectious Diseases, Farhat-Hached University hospital, 4000 Sousse, Tunisia; University of Sousse, Faculté de Médecine Ibn-Al-Jazzar, 4000 Sousse, Tunisia
| | - A Letaief
- Department of Infectious Diseases, Farhat-Hached University hospital, 4000 Sousse, Tunisia; University of Sousse, Faculté de Médecine Ibn-Al-Jazzar, 4000 Sousse, Tunisia
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13
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Dal Bo S, Calandriello L, Biserna L, Mantero F, Minguzzi T, Marchetti F. [A sepsis that you don't expect… Lemierre's syndrome. Description of a clinical case.]. Recenti Prog Med 2019; 110:543-547. [PMID: 31808441 DOI: 10.1701/3265.32329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A healthy 16-year-old boy was hospitalized for fever, septic condition and thrombosis of the left internal jugular vein: The diagnosis of Lemierre syndrome (LS) with positive blood culture for Fusobacterium necrophorum was formalized. He was treated with antibiotics and anticoagulant therapy with enoxaparin with complete recovery. Four weeks after discharge, the jugular vein ecodoppler showed complete resolution of the thrombosis. LS is characterized by thrombosis of the internal jugular vein and anaerobic bacteremia often caused by Fusobacterium necrophorum. It is a rare disease in the post-antibiotic era, but with an increase in cases over the last twenty years. LS should be suspected in young, healthy patients with persistent pharyngitis followed by sepsis, pneumonia or atypical laterocervical pain. The diagnosis is confirmed by the identification of jugular venous thrombosis and is further confirmed by the growth of anaerobic bacteria on blood culture. Prolonged antibiotic and anticoagulant therapies are the essential elements of treatment. However, anticoagulant therapy for internal venous thrombosis associated with LS remains a controversy.
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Affiliation(s)
- Sara Dal Bo
- UOC di Pediatria e Neonatologia, Ospedale di Ravenna, AUSL della Romagna
| | | | - Loretta Biserna
- UOC di Pediatria e Neonatologia, Ospedale di Ravenna, AUSL della Romagna
| | | | | | - Federico Marchetti
- UOC di Pediatria e Neonatologia, Ospedale di Ravenna, AUSL della Romagna
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14
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Liu YC, Lee WJ. Lemierre's syndrome: a possible cause of neck pain. Intern Emerg Med 2019; 14:1339-1340. [PMID: 31535288 DOI: 10.1007/s11739-019-02194-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/07/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Yu-Chang Liu
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, 710, Taiwan
| | - Wei-Jing Lee
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, 710, Taiwan.
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15
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Sethi A, Sankar MJ, Thukral A, Saxena R, Chaurasia S, Agarwal R. Prophylactic Vitamin K Administration in Neonates on Prolonged Antibiotic Therapy: A Randomized Controlled Trial. Indian Pediatr 2019; 56:463-467. [PMID: 31278224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To compare the prevalence of vitamin K deficiency after intramuscular vitamin K or no treatment in neonates with sepsis on prolonged (>7 days) antibiotic therapy. STUDY DESIGN Open label randomized controlled trial. SETTING Level 3 Neonatal Intensive Care Unit (NICU). PARTICIPANTS Neonates with first episode of sepsis on antibiotics for ≥7 days were included. Neonates with clinical bleeding, vitamin K prior to start of antibiotic therapy (except the birth dose), cholestasis or prenatally diagnosed bleeding disorder were excluded. INTERVENTIONS Randomized to receive 1 mg vitamin K (n=41) or no vitamin K (n=39) on the 7th day of antibiotic therapy. MAIN OUTCOME MEASURES Vitamin K deficiency defined as Protein Induced by Vitamin K Absence (PIVKA-II) >>2 ng/mL after 7 ± 2 days of enrolment. RESULTS The prevalence of vitamin K deficiency was 100% (n=80) at enrolment and it remained 100% even after 7 ± 2 days of enrolment in both the groups. CONCLUSIONS Neonates receiving prolonged antibiotics have universal biochemical vitamin K deficiency despite vitamin K administration on 7th day of antibiotic therapy.
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Affiliation(s)
- Amanpreet Sethi
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - M Jeeva Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Thukral
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Renu Saxena
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Chaurasia
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Agarwal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Dr Ramesh Agarwal, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110 029, India.
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16
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Mirfazaelian H, Akhgar A, Farajidaneshgar F, Daneshbod Y. Photoclinic. Arch Iran Med 2018; 21:378-379. [PMID: 30113861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 06/03/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Hadi Mirfazaelian
- Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Atousa Akhgar
- Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Yahya Daneshbod
- Shiraz Molecular Pathology Research Center, Dr Daneshbod Laboratory, Shiraz, Iran
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17
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Chera HH, Cohen M, Ishakis R, Rosen Y, Ozeri DJ. Lemierre's Syndrome in an Aseptic Patient with Systemic Lupus Erythematosus. Isr Med Assoc J 2018; 20:448-450. [PMID: 30109797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Hymie H Chera
- Department of Medicine and Rheumatology, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Max Cohen
- College of Osteopathic Medicine, New York Institute of Technology, Glen Head, NY, USA
| | - Robert Ishakis
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yitzhak Rosen
- Department of Medicine and Rheumatology, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - David J Ozeri
- Department of Medicine, Division of Rheumatology, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn NY, USA
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Yaita K, Sugi S, Hayashi M, Koga T, Ebata T, Sakai Y, Kaieda S, Ida H, Watanabe H. The co-existence of Lemierre's syndrome and Bezold's abscesses due to Streptococcus constellatus: A case report. Medicine (Baltimore) 2018; 97:e11228. [PMID: 29952983 PMCID: PMC6039683 DOI: 10.1097/md.0000000000011228] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE The ancient infectious diseases, Lemierre's Syndrome and Bezold's Abscesses are rare. PATIENT CONCERNS A 70-year-old Japanese woman with a 15-year history of Parkinson's disease was referred to our hospital due to fever, occipital headache and bilateral shoulder pain that had continued for three months. She had been prescribed prednisolone due to a diagnosis of polymyalgia rheumatica. DIAGNOSES A blood culture revealed bacteremia of Streptococcus constellatus. In addition, computed tomography revealed Bezold's abscesses and Lemierre's syndrome. INTERVENTIONS We administered ceftriaxone for 31 days, followed by oral amoxicillin. OUTCOMES The patient recovered and the abscesses improved. LESSONS This case underscores the importance of blood culture tests and cross-referencing with radiological imagings in the diagnoses of these rare critical infectious diseases that mimic polymyalgia rheumatica.
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Affiliation(s)
- Kenichiro Yaita
- Department of Infection Control and Prevention, Kurume University School of Medicine
| | - Suzuna Sugi
- Department of Medicine, Division of Respirology, Neurology, and Rheumatology
| | - Makiko Hayashi
- Department of Medicine, Division of Respirology, Neurology, and Rheumatology
| | - Takuma Koga
- Department of Medicine, Division of Respirology, Neurology, and Rheumatology
| | - Tomohiro Ebata
- Department of Radiology and Center for Diagnostic Imaging
| | - Yoshiro Sakai
- Department of Infection Control and Prevention, Kurume University School of Medicine
- Department of Pharmacy, Kurume University Hospital, Kurume, Fukuoka, Japan
| | - Shinjiro Kaieda
- Department of Medicine, Division of Respirology, Neurology, and Rheumatology
| | - Hiroaki Ida
- Department of Medicine, Division of Respirology, Neurology, and Rheumatology
| | - Hiroshi Watanabe
- Department of Infection Control and Prevention, Kurume University School of Medicine
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Martel A. Septic thrombosis of cavernous sinus extended to the ipsilateral internal jugular vein and transversal sinus with favorable outcome: Clinical and radiological features of a Lemierre syndrome. Orbit 2018; 37:94-96. [PMID: 29040036 DOI: 10.1080/01676830.2017.1383458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 06/07/2023]
Abstract
An 86-year-old patient was hospitalized for fever and left acute orbital syndrome (red eye with moderate visual impairment, chemosis, ophthalmoplegia without proptosis, or any fundus involvement). CT scan showed superior ophthalmic vein and cavernous sinus enlargement complicating ipsilateral sphenoidal sinusitis. Magnetic resonance imaging (MRI) demonstrated the left cavernous sinus thrombosis extended to the ipsilateral jugular vein and transversal sinus (Lemierre syndrome). Intravenous broad-spectrum antibiotics and curative anticoagulation were prescribed. Blood cultures allowed the identification of Streptococcus intermedius and Staphylococcus warneri species. Evolution was favorable and the patient was discharged 3 weeks after. Antibiotics and anticoagulation were carried out for a total duration of 4 and 12 weeks, respectively. Lemierre syndrome is a potentially life-threatening emergency rarely encountered; thus, ophthalmologists should be cognizant of clinical and radiological features. Broad-spectrum antibiotics are the mainstay of treatment. Curative anticoagulation may be added if no blood coagulation disorder nor bleeding on neuroimaging has been identified.
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Affiliation(s)
- Arnaud Martel
- a Department of Ophthalmology , University Hospital of Nice , Nice , France
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20
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Hedenmark J, Holm K, Moberger F, Torell E. [Not Available]. Lakartidningen 2018; 115:EWPE. [PMID: 29406559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this case report and discussion is to heighten the awareness of Lemierres syndrome (postanginal sepsis). Affected patients present in various fields of medicine and an increased incidence of "the forgotten disease" may be expected. Fusobacterium necrophorum is the most common pathogen. The clinical course includes a primary head or neck infection with thrombosis of the internal jugular vein with subsequent septic pulmonary embolization. The syndrome bears considerable morbidity and even mortality. People aged 15-25 years are commonly affected. Early diagnosis through positive blood culture and confirmation of jugular vein thrombosis combined with prompt antibiotic treatment and source control is mandatory in the management of Lemierre's syndrome. Assessment of vital organ function is recommended across the continuum of care as this facilitates recognition and initiation of therapeutic measures to counteract a complicated clinical course.
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Affiliation(s)
- Jan Hedenmark
- VO Anestesi, Div Operation, Hudiksvalls sjukhus, 824 81 Hudiksvall - Hudiksvall, Sweden - VO Anestesi Hudiksvall, Sweden
| | - Karin Holm
- VO Infektionssjukdomar, Skånes Universitetssjukhus, Lund - Lund, Sweden VO Infektionssjukdomar, Skånes Universitetssjukhus, Lund - Lund, Sweden
| | - Fredrik Moberger
- Bild och funktionsmedicin, Hudiksvalls sjukhus, 824 81 Hudiksvall - Hudiksvall, Sweden Bild och funktionsmedicin, Hudiksvalls sjukhus, 824 81 Hudiksvall - Hudiksvall, Sweden
| | - Erik Torell
- VO specialmedicn, infektion, Gävle sjukhus - Gävle, Sweden 1 - Gävle, Sweden
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21
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Abstract
Lemierre's syndrome is rare, with no known reported cases in the Caribbean thus far. We highlight a case of a young woman who presented with diabetic ketoacidosis precipitated by oral pharyngeal sepsis, whose condition rapidly deteriorated within 24 hours requiring ventilation and administration of antibiotics. Her sepsis was accompanied by internal jugular vein thrombosis in keeping with a diagnosis of Lemierre's syndrome, which was treated aggressively with antibiotics, intensive care and mechanical ventilatory support in the intensive care unit. She made a full recovery. Though this is the first reported case in the Caribbean of this ‘forgotten disease’, it must not be forgotten because prognosis and outcome are markedly improved with prompt and aggressive treatment.
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Affiliation(s)
- Mandreker Bahall
- Department of Clinical and Medical Sciences, University of the West Indies., St. Augustine, Trinidad and Tobago
| | - Stanley Giddings
- Department of Clinical and Medical Sciences, University of the West Indies., St. Augustine, Trinidad and Tobago
| | - Krishni Bahall
- Department of Medicine, San Fernando General Hospital, San Fernando., Trinidad and Tobago
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22
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Irvin MA, Clayton DB, Harris DM. 59-Year-Old Man With Sore Throat and Fever. Mayo Clin Proc 2017; 92:e101-e104. [PMID: 28599748 DOI: 10.1016/j.mayocp.2016.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/09/2016] [Accepted: 10/12/2016] [Indexed: 11/23/2022]
Affiliation(s)
- Myra A Irvin
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Donnesha B Clayton
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Dana M Harris
- Advisor to Residents and Consultant in Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL
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Cupit-Link MC, Nageswara Rao A, Warad DM, Rodriguez V. Lemierre Syndrome: A Retrospective Study of the Role of Anticoagulation and Thrombosis Outcomes. Acta Haematol 2016; 137:59-65. [PMID: 28006761 DOI: 10.1159/000452855] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 10/16/2016] [Indexed: 11/19/2022]
Abstract
Lemierre syndrome (LS) is a multisystemic infection beginning in the oropharynx and leading to thrombosis of the internal jugular vein (IJV) with septic emboli and potential thrombotic extension to the central nervous system. Although patient outcomes have improved with early initiation of antimicrobial therapies, there is no consensus regarding the role of anticoagulation in LS. To better define the role of anticoagulation therapy in LS and determine whether anticoagulation improves thrombosis outcomes, we conducted a retrospective chart review of pediatric and adult patients diagnosed with LS and managed at our institution from January 1998 to December 2014. Eighteen patients (9 females and 9 males) were included in this analysis, 6 of whom received ≥4 weeks of anticoagulation therapy (median 23.1 weeks, range 6.9-32.9 weeks). Six patients were in the pediatric age group (<18 years). All patients received broad-spectrum antibiotics. All patients had improvement in their thrombi by 3 months (nonanticoagulated patient group: complete response [CR], n = 9; partial response [PR], n = 3; anticoagulated patient group: CR, n = 2; PR, n = 4). No patient developed recurrent thrombosis or progression during the follow-up period, regardless of anticoagulation status. Our study suggests that anticoagulation in LS may not affect thrombosis outcomes.
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Gulliford MC, Moore MV, Little P, Hay AD, Fox R, Prevost AT, Juszczyk D, Charlton J, Ashworth M. Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records. BMJ 2016; 354:i3410. [PMID: 27378578 PMCID: PMC4933936 DOI: 10.1136/bmj.i3410] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To determine whether the incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre's syndrome is higher in general practices that prescribe fewer antibiotics for self limiting respiratory tract infections (RTIs). DESIGN Cohort study. SETTING 610 UK general practices from the UK Clinical Practice Research Datalink. PARTICIPANTS Registered patients with 45.5 million person years of follow-up from 2005 to 2014. EXPOSURES Standardised proportion of RTI consultations with antibiotics prescribed for each general practice, and rate of antibiotic prescriptions for RTIs per 1000 registered patients. MAIN OUTCOME MEASURES Incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre's syndrome, adjusting for age group, sex, region, deprivation fifth, RTI consultation rate, and general practice. RESULTS From 2005 to 2014 the proportion of RTI consultations with antibiotics prescribed decreased from 53.9% to 50.5% in men and from 54.5% to 51.5% in women. From 2005 to 2014, new episodes of meningitis, mastoiditis, and peritonsillar abscess decreased annually by 5.3%, 4.6%, and 1.0%, respectively, whereas new episodes of pneumonia increased by 0.4%. Age and sex standardised incidences for pneumonia and peritonsillar abscess were higher for practices in the lowest fourth of antibiotic prescribing compared with the highest fourth. The adjusted relative risk increases for a 10% reduction in antibiotic prescribing were 12.8% (95% confidence interval 7.8% to 17.5%, P<0.001) for pneumonia and 9.9% (5.6% to 14.0%, P<0.001) for peritonsillar abscess. If a general practice with an average list size of 7000 patients reduces the proportion of RTI consultations with antibiotics prescribed by 10%, then it might observe 1.1 (95% confidence interval 0.6 to 1.5) more cases of pneumonia each year and 0.9 (0.5 to 1.3) more cases of peritonsillar abscess each decade. Mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre's syndrome were similar in frequency at low prescribing and high prescribing practices. CONCLUSIONS General practices that adopt a policy to reduce antibiotic prescribing for RTIs might expect a slight increase in the incidence of treatable pneumonia and peritonsillar abscess. No increase is likely in mastoiditis, empyema, bacterial meningitis, intracranial abscess, or Lemierre's syndrome. Even a substantial reduction in antibiotic prescribing was predicted to be associated with only a small increase in numbers of cases observed overall, but caution might be required in subgroups at higher risk of pneumonia.
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Affiliation(s)
- Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King's College London, Guy's Campus, London SE1 1UL, UK
| | - Michael V Moore
- Academic Unit for Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Paul Little
- Academic Unit for Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Robin Fox
- The Health Centre, Bicester, Oxford, UK
| | - A Toby Prevost
- Department of Primary Care and Public Health Sciences, King's College London, Guy's Campus, London SE1 1UL, UK
| | - Dorota Juszczyk
- Department of Primary Care and Public Health Sciences, King's College London, Guy's Campus, London SE1 1UL, UK
| | - Judith Charlton
- Department of Primary Care and Public Health Sciences, King's College London, Guy's Campus, London SE1 1UL, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, King's College London, Guy's Campus, London SE1 1UL, UK
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Affiliation(s)
- Jacqueline Botros
- Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA, USA,
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26
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Affiliation(s)
- H U Rehman
- From the University of Saskatchewan, Regina Qu'Appelle Health Region, Regina, SK, S4P 3X1, Canada
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27
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Asnani J, Jones S. Case review. Lemierre's syndrome. J Fam Pract 2014; 63:193-196. [PMID: 24905121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A previously healthy 35-year-old man with a one-week history of left-sided neck pain and fever as high as 104°F sought care at our emergency department. He was given a diagnosis of viral pharyngitis and discharged. He returned the next day and indicated that he was now experiencing drenching night sweats and weakness.
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Affiliation(s)
- Jessica Asnani
- Family Medicine, University of Connecticut, Hartford, CT, USA.
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28
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McGouran D, Keene A, Walklin R, Carter J. A complex case of bilateral Lemierre syndrome with suggestions on anticoagulation management. Intern Med J 2014; 43:728-30. [PMID: 23745997 DOI: 10.1111/imj.12162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 02/08/2013] [Indexed: 11/28/2022]
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29
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Murthy KAS, Thippeswamy T, Kiran HS, Venkatesh CR, Harsha S, Shetty TS, Shukla A. The 'forgotten disease' (or the never known). J Assoc Physicians India 2013; 61:754-757. [PMID: 24772738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Lemierre's syndrome is an acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein and frequent metastatic infections. Despite its rarity, it is important to have a high degree of clinical suspicion to recognise it early. A history of sore throat followed by metastatic infections and abscesses should alert the clinician to the possibility of this unusual infection. We present a case of Lemierre's syndrome presenting with meningitis in a previously healthy young adult along with a review of the pathophysiology of necrobacillosis and its diagnosis, diagnostic difficulty and treatment.
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30
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Dubois G, Damas F, Fraipont V. [Clinical case of the month. An unusual sepsis]. Rev Med Liege 2013; 68:387-390. [PMID: 24053095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Lemierre's syndrome is a rare, but significant pathology to recognize. It most often affects young patients in good health; a late diagnosis can be fatal. It consists in an anaerobic septicemia (usually, Fusobacterium necrophorum) originating from a suppurative thrombophlebitis of the internal jugular vein. Infection occurs during a common sore throat and spreads by contiguity. The clinical presentation is a sepsis with pulmonary embolisations, but other sites of dissemination can also occur. Treatment consists of prolonged intravenous antibiotherapy associated with supportive therapy, if needed. Anticoagulation remains controversial. The outcome is favorable in most cases provided diagnosis and treatment are early; mortality however remains significant, around 5%.
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Affiliation(s)
- G Dubois
- Service des Soins Intensifs, CHR Citadelle, Liège
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31
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Astradsson T, Ekspong L, Norlander T. [Lemierre syndrome is a forgotten disease that primarily affects young people. Early antibiotic treatment can prevent fatal outcome]. Lakartidningen 2013; 110:413-415. [PMID: 23488437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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32
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33
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Ji YQ, Wang J, Kong LQ, Juggessur-Mungur KS, Wu TH, Zhang ZH. Lemierre syndrome caused by Arcanobacterium haemolyticum. Chin Med J (Engl) 2013; 126:391-392. [PMID: 23324298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- Ying-Qun Ji
- Department of Respiratory Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
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34
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Lim AL, Pua KC. Lemierre syndrome. Med J Malaysia 2012; 67:340-341. [PMID: 23082433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Lemierre syndrome is an uncommon disease which commonly arise from acute bacterial oropharyngeal infection. This disease was first described in 1900 by Courmont and Cade Lemierre. It is commonly caused by Fusobacterium necrophorum. Lemierre syndrome has been reported to be serious and potentially fatal in the preantibiotic era. It is characterized by an oropharyngeal infection leading to secondary septic thrombophlebitis of the internal jugular vein with embolization to the lungs and other organs. The incidence has become relatively rare at present and is usually only diagnosed when unsuspected culture results are available. We report a case of Lemierre syndrome which was recently diagnosed in our centre.
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Affiliation(s)
- Ai Lee Lim
- Department of Otorhinolarngology, Hospital Pulau Pinang, Jalan Residensi, 10990 Penang.
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35
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Reinholdt Jensen J, Weinreich UM. [Lemierre's syndrome as differential diagnosis of lung cancer]. Ugeskr Laeger 2012; 174:1533-1534. [PMID: 22668649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Lemierre's syndrome is a disseminated infection which is usually caused by Fusobacterium necrophorum. An oropharyngeal infection progresses to a septic thrombophlebitis of the internal jugular vein and later metastatic infections throughout the body occur. We present a clinical case in which a patient, initially presenting with symptoms characteristic of pulmonary cancer, turned out to have a rare variant of Lemierre's syndrome caused by Fusobacterium nucleatum.
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Affiliation(s)
- Jacob Reinholdt Jensen
- Lungemedicinsk Afdeling, Medicinerhuset, Mølleparkvej 4, Postboks 561, 9100 Aalborg, Denmark.
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36
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Abstract
Lemierre's syndrome is usually reported in the young and in fit individuals. We report a case of an 81-year-old woman who presented with thrombophlebitis of the internal jugular vein with a pulmonary embolism.
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37
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Krishna K, Diwan AG, Gupt A. Lemierre's syndrome--the syndrome quite forgotten. J Assoc Physicians India 2012; 60:60-63. [PMID: 22799122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 17 year old male presented with seizures, headache, and fever and left chronic suppurative otitis media. A 35 year old male presented with headache, giddiness, vomiting, pain in eyes, diplopia and right chronic suppurative otitis media. Brain imaging in both revealed thrombosis of lateral and sigmoid sinus and also of internal jugular vein on the left and right side respectively. A diagnosis of Lemierre's syndrome was made in both. They were treated with antibiotics and anticoagulants, and they responded to treatment. We want to report this case as we feel, that with the advent of the antibiotic era, this syndrome has become rare; and so "quite forgotten" or overlooked, by many physicians.
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Affiliation(s)
- Kavita Krishna
- Department of Medicine, Bharati Vidyapeeth University Medical College and Bharati Hospital, Dhankawadi, Pune 411043, Maharashtra, India
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38
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Busscher MGH, Kruijff S. [A man with a painful, swollen neck and fever]. Ned Tijdschr Geneeskd 2012; 156:A3239. [PMID: 22742440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Lemierre's syndrome is a rare condition mostly secondary caused by an oropharyngeal infection with Fusobacterium necrophorum. We report a 62-year-old man with a classic case of Lemierre's syndrome, most likely caused by a diminished immunity as a result of an underlying chronic lymphatic leukemia.
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39
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Abstract
Lemierre's syndrome (LS) is characterized by pharyngitis followed by septicemia, internal jugular vein thrombophlebitis, and metastatic embolization in general. LS is commonly caused by Fusobacterium necrophorum. Herein, we present a case of LS with liver abscesses that presented as a sole metastatic lesion. We were not able to diagnose LS until Fusobacterium necrophorum was isolated due to the lack of the common involvement. Doripenem was effective against the pathologic features including the liver abscesses. LS should be taken into consideration when clinicians find liver abscesses following pharyngitis even when the common complications of LS are not detected.
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Affiliation(s)
- Tomohiro Iwasaki
- Department of Internal Medicine, Nanbugo General Hospital, Japan.
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40
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Gülmez D, Alp S, Topeli İskit A, Akova M, Hasçelik G. [Pneumonia caused by Fusobacterium necrophorum: is Lemierre syndrome still current?]. MIKROBIYOL BUL 2011; 45:729-734. [PMID: 22090304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Fusobacterium necrophorum is a non-spore-forming gram-negative anaerobic bacillus that may be the causative agent of localized or severe systemic infections. Systemic infections due to F.necrophorum are known as Lemierre's syndrome, postanginal sepsis or necrobacillosis. The most common clinical course of severe infections in humans is a progressive illness from tonsillitis to septicemia in previously healthy young adults. A septic thrombophlebitis arising from the tonsillar veins and extending into the internal jugular vein leads to septicemia and septic emboli contributing to the development of necrotic abscesses especially in lungs and other tissues such as liver, bone and joints. In this case report, a previously healthy man with pneumonia and empyema due to F.necrophorum has been presented. A 22 year-old man suffering from sore throat for seven days was admitted to emergency department with ongoing fever and dysphagia for three days. On admission he was already taking amoxicillin-clavulanic acid and his complaints were relieved with continuation of therapy to a total of 10 days. However, five days after the cessation of treatment he developed productive cough, fever and generalized myalgia. On physical examination, there were crackles on right lower lung, and chest X-ray revealed pulmonary consolidation on the right middle lobe. Levofloxacin therapy was started based on the diagnosis of pneumonia. While polymorphonuclear leucocytes and intracellular gram-negative bacilli were seen in Gram stained sputum smear, sputum culture was reported as normal flora. Although the patient's status had started to improve with treatment, his condition deteriorated with development of fever and dyspnea. Chest X-ray revealed consolidation, pulmonary infiltrates, pleural effusion and air-fluid level on the right. Meropenem, clarithromycin and linezolid were initiated and a chest tube was inserted with the preliminary diagnosis of necrotizing pneumonia, empyema and type-1 respiratory failure. While there was no growth on bronchoalveolar lavage fluid culture, thoracentesis material inoculated into thioglycolate broth revealed turbidity. Further inoculation onto Schaedler agar which was incubated under anaerobic conditions, yielded growth of catalase negative, indol positive, gram-negative anaerobic bacilli identified as F.necrophorum by BBL Crystal system (Becton Dickinson, USA). The detailed history of the patient revealed that fish bone had stuck in his throat a week ago. Clarithromycin and linezolid were discontinued and he was recovered within six weeks of meropenem treatment. F.necrophorum infection should be considered in the differential diagnosis of persistent head and neck infections with rapidly progressive metastatic necrotic lesions especially in healthy young adults and clindamycin or metranidazol should be added to the treatment protocols.
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Affiliation(s)
- Dolunay Gülmez
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey.
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41
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Paudyal BP. Lemierre's syndrome in a patient with severe lupus nephritis. JNMA J Nepal Med Assoc 2011; 51:137-140. [PMID: 22922861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Lemierre's syndrome is a rare septic thrombophlebitis of the internal jugular vein with frequent metastatic complications following an acute oropharyngeal infection. Immunocompromised patients are at higher risk of developing this syndrome owing to the decreased host response and increased risk of oropharyngeal sepsis. We herein report a 24-year-old woman with severe lupus nephritis on immunosuppressive therapy, who developed Lemierre's syndrome following a pharyngeal infection despite an adequate and timely antibiotic therapy. We hereby draw an attention to the importance of accurate and timely diagnosis and appropriate management of Lemierre's syndrome in immunocompromised patients so as to achieve a successful prognosis for this deadly infection.
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Affiliation(s)
- B P Paudyal
- Department of Medicine, Patan Academy of Health Sciences, Nepal.
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42
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Naito A, Jujo T, Kuroda F, Kozono T, Sakurai T, Tatsumi K. [A case of Lemierre syndrome]. Nihon Kokyuki Gakkai Zasshi 2011; 49:449-453. [PMID: 21735747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Classic Lemierre syndrome is a septic internal jugular venous thrombophlebitis secondary to oropharyngeal anaerobic infection in adolescents and young adults. Upper respiratory tract infection is the most common antecedent. We report a case of Lemierre syndrome as a rare infectious disease. A 20-year-old man complained of high fever, right neck discomfort and chest pain. Chest X-ray revealed infiltrative shadows, suggesting bacterial pneumonia. Although cefcapene pivoxil hydrochloride hydrate (CFPN-PI) was given in a local clinic, his symptoms did not improve. Then he was referred to our hospital. Chest CT findings showed bilateral multiple nodular shadows with small cavities, suggesting septic embolization. Fusobacterium necrophorum was cultured from specimen of the blood, and an enhanced neck CT scan showed thrombosis in the right internal jugular vein. These findings led us to a diagnosis of Lemierre syndrome. Four weeks of antibiotics and anticoagulants ameliorated inflammatory findings in blood, but internal jugular vein thrombosis remained. Currently, there is no consensus opinion on the use of anticoagulation in patients with Lemierre syndrome complicated by septic internal jugular thrombosis and embolism. Early and effective antibiotics therapy may prevent the development of the syndrome and its associated complication, although it is unclear whether the outcome will be favorable.
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Affiliation(s)
- Akira Naito
- Department of Respiratory Medicine, Chiba Municipal Hospital
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Centor RM, Samlowski R. Avoiding sore throat morbidity and mortality: when is it not "just a sore throat?". Am Fam Physician 2011; 83:26-28. [PMID: 21888123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Abstract
Lemierre's syndrome is a rare clinical syndrome defined as orophyngeal sepsis, thrombophlebitis of the internal jugular vein and septic thombo-emboli. It is typically encountered in young, immunocompetent individuals, with a mean incident age of 20 years. The organism that is most commonly associated is an anaerobic Gram-negative bacterium: Fusobacterium species. The defined treatment course is at least six weeks of antibiotics, with the role of anticoagulation being unclear. The present article documents a case of Lemierre's syndrome complicated by acute renal failure and loculated pleural effusion in an otherwise healthy 16-year-old patient.
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Affiliation(s)
- Jacquelyn Dirks
- Division of Respirology, Department of Intensive Medicine, Dalhousie University, Halifax, Canada.
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