887 Suspected malignancy and unusual pathology in a severe case of Lemierre’s syndrome

Abstract Lemierre’s syndrome, although rare, is a potentially fatal condition, usually associated with the anaerobic bacterium, Fusobacterium necrophorum. This case describes a previously healthy 59-year-old female, who had a three-week history of pharyngitis and dysphagia. She presented to the emergency department with a left neck swelling and fever. A CT scan showed a 3 cm left level IV low-density suspected neck mass or necrotic node. There were multiple pulmonary nodules raising suspicion for metastases. Blood cultures were positive for Streptococcus constellatus and Dialister pneumosintes. The scan was further reviewed by a Head and Neck specialist radiologist and an Oral and Maxillofacial consultant, which highlighted a peritonsillar abscess and filling defect in the left internal jugular vein. A conclusive diagnosis of Lemierre’s syndrome with septic pulmonary emboli was established. She improved clinically with IV antibiotics in conjunction with daily enoxaparin injections. We believe that this is the first reported case of Lemierre’s syndrome associated with Dialister pneumosintes. A high index of suspicion is essential in cases of persistent pharyngitis and sepsis in an otherwise healthy individual, in order to promptly diagnose the condition and initiate treatment.

Download Full-text

Lemierre's syndrome associated with consumption coagulopathy and acute renal failure: a case report

The Journal of Laryngology & Otology ◽

10.1017/s0022215107007256 ◽

2007 ◽

Vol 122 (5) ◽

pp. 527-530 ◽

Cited By ~ 3

Author(s):

S Georgopoulos ◽

S Korres ◽

M Riga ◽

D Balatsouras ◽

G Kotsis ◽

...

Keyword(s):

Case Report ◽

Jugular Vein ◽

Fusobacterium Necrophorum ◽

Consumption Coagulopathy ◽

Lemierre’S Syndrome ◽

Acute Tonsillitis ◽

Respiratory Deficiency ◽

Life Threatening ◽

Lemierre's Syndrome ◽

High Index Of Suspicion

AbstractBackground:Acute tonsillitis or pharyngitis may lead to suppurative thrombophlebitis of the internal jugular vein. This complication, also known as Lemierre's syndrome, remains, even nowadays, life threatening, due to dissemination of septic thromboemboli to various organs. Respiratory deficiency and renal impairment are often reported in patients suffering from Lemierre's syndrome.Case report:The unusual clinical manifestation of this case involves severe acute renal and respiratory deficiency in addition to microangiopathic consumption coagulopathy in a young patient treated with macrolides five days after the onset of acute tonsillitis.Conclusion:The usual causative pathogen, namelyFusobacterium necrophorum, shows a varying sensitivity to macrolides. As a result, the syndrome may present itself in a variety of clinical forms even in patients under treatment with macrolides. A high index of suspicion is therefore crucial for in time prevention of potentially life threatening complications.

Download Full-text

A Rare Case of Lemierre’s Syndrome in a Male Division I Collegiate Football Player

International Journal of Athletic Therapy & Training ◽

10.1123/ijatt.2014-0057 ◽

2015 ◽

Vol 20 (5) ◽

pp. 11-15

Author(s):

Heather Fahsl ◽

Shannon David

Keyword(s):

Signs And Symptoms ◽

Fusobacterium Necrophorum ◽

Football Player ◽

Peritonsillar Abscess ◽

Division I ◽

Lemierre’S Syndrome ◽

Night Sweats ◽

Lemierre's Syndrome ◽

Collegiate Football ◽

Nose And Throat

During the fall preseason of 2013, a 19-year-old Division I linebacker (body mass = 104 kg; height = 189 cm) attending a college football camp developed severe throat pain, quickly followed by night sweats, fever, nausea, vomiting, shortness of breath, and generalized body weakness. The athletic trainer believed that the athlete had a cold. Because symptoms did not improve, the athlete was referred to several physicians with different specialties and underwent standard testing. The ears, nose, and throat (ENT) physician recognized the signs and symptoms of Lemierre’s syndrome based on a previous case seen only once in his career. A computed tomography (CT) scan confirmed the presence of a peritonsillar abscess and thrombosis of the left internal jugular vein, which justified further investigation for this rare syndrome. A positive blood culture for Fusobacterium necrophorum confirmed the diagnosis of Lemierre’s syndrome. Several antibiotics and anticoagulation medications were prescribed and the athlete was closely monitored. After two months, he was cleared to play football.

Download Full-text

Lemierre’s syndrome: a forgotten life-threatening entity

BMJ Case Reports ◽

10.1136/bcr-2020-236201 ◽

2020 ◽

Vol 13 (10) ◽

pp. e236201

Author(s):

Rita Gama ◽

Manuel Sousa ◽

Fernanda Castro ◽

Artur Condé

Keyword(s):

Jugular Vein ◽

Final Diagnosis ◽

Fusobacterium Necrophorum ◽

Peritonsillar Abscess ◽

Adult Males ◽

Lemierre’S Syndrome ◽

Family Doctors ◽

Life Threatening ◽

Lemierre's Syndrome ◽

Nose And Throat

Lemierre’s syndrome is a very rare but potentially fatal condition. It mainly affects adolescents and young adult males, and usually arises as a serious complication of pharyngitis or peritonsillar abscess. It is characterised by the triad of internal jugular vein septic thrombophlebitis, septic emboli (mostly pulmonary) and the isolation of the agent ‘Fusobacterium necrophorum’ in sterile fluids. In this report, it is described a case in which the nonspecific and subtle clinic made the diagnosis difficult to reach. In fact, only the dissociation between flu-like symptoms and the presence of significant changes in the blood tests (suggestive of acute bacterial infection), led to the request for imaging tests, which proved to be essential for the final diagnosis and subsequent control of the disease. This case report aims to increase the awareness among Ear, Nose and Throat (ENT) residents, paediatricians and family doctors about the existence of this entity and its potential life-threatening nature.

Download Full-text

Lemierre’s syndrome as a consequence of acute supraglottitis

The Journal of Laryngology & Otology ◽

10.1258/0022215021910375 ◽

2002 ◽

Vol 116 (3) ◽

pp. 216-218 ◽

Cited By ~ 5

Author(s):

Andrew Hope ◽

Nigel Bleach ◽

Sabour Ghiacy

Keyword(s):

Computed Tomography ◽

Jugular Vein ◽

Fusobacterium Necrophorum ◽

Lemierre’S Syndrome ◽

Jugular Vein Thrombosis ◽

Vein Thrombosis ◽

Intravenous Antibiotics ◽

Intracranial Thrombosis ◽

Internal Jugular Vein Thrombosis ◽

Lemierre's Syndrome

Lemierre’s syndrome comprises internal jugular vein thrombosis following oropharyngeal sepsis and is a rare and serious condition. It is most commonly caused by the anaerobe Fusobacterium necrophorum and typically presents as metastatic sepsis to the lungs and joints. Thrombosis is demonstrated by computed tomography (CT) of the neck, and it is routinely treated with intravenous antibiotics and anti-coagulation.We describe a case of Lemierre’s syndrome following acute supraglottitis. The clinical features were of retrograde intracranial thrombosis, rather than the more usual metastatic sepsis.

Download Full-text

The Forgotten Disease: A Case of Lemierre’s Syndrome with Distal Extremity Involvement

Case Reports in Infectious Diseases ◽

10.1155/2020/4346937 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

John Gaskill ◽

Michael Aronson

Keyword(s):

Care Center ◽

Tertiary Care ◽

Rare Condition ◽

Fusobacterium Necrophorum ◽

Lemierre’S Syndrome ◽

Intravenous Antibiotics ◽

Adjacent Structures ◽

Oropharyngeal Infection ◽

Fluid Collections ◽

Lemierre's Syndrome

Once coined the “Forgotten Disease,” Lemierre’s syndrome is a rare condition that results from oropharyngeal infection with the gram-negative, anaerobic Fusobacterium necrophorum. The typical progression of illness involves spread to adjacent structures such as the internal jugular vein with resulting thrombophlebitis. Septic emboli to distant sites are also a common sequela. Here, we present a case of Lemierre’s syndrome in a 20-year-old, otherwise healthy, male. The patient presented with fever, sore throat, and dysphagia. Imaging revealed peritonsillar multiloculated fluid collections and necrotizing pneumonia with multiple pulmonary abscesses. The patient’s hospital course was complicated by the development of necrotizing fasciitis in his right lower leg, which required incision and drainage with surgical washout. In addition to systemic intravenous antibiotics and anticoagulation, he underwent multiple thoracentesis procedures. The patient was ultimately transferred to a tertiary care center due to persistent fevers and lung abscesses. This case highlights the challenges of initial diagnosis, as well as the treatment choices faced by the attending physicians.

Download Full-text

719A Rare Variant of Lemierre's Syndrome – Fusobacterium necrophorum Sepsis from Gynecological Origin

Open Forum Infectious Diseases ◽

10.1093/ofid/ofu052.427 ◽

2014 ◽

Vol 1 (suppl_1) ◽

pp. S203-S203

Author(s):

Shivani Garg ◽

Jorge Mora ◽

Glenn Eiger

Keyword(s):

Rare Variant ◽

Fusobacterium Necrophorum ◽

Lemierre’S Syndrome ◽

Lemierre's Syndrome

Download Full-text

Human Infection withFusobacterium necrophorumwithout Jugular Venous Thrombosis: A Varied Presentation of Lemierre’s Syndrome

Case Reports in Infectious Diseases ◽

10.1155/2017/5358095 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

Muhammad Asim Rana ◽

Yashwant Kumar ◽

Abdullah Ali Lashari ◽

Ahmed F. Mady

Keyword(s):

Nerve Palsy ◽

Jugular Vein ◽

Kidney Injury ◽

Severe Pneumonia ◽

Fusobacterium Necrophorum ◽

Human Infection ◽

Upper Respiratory Tract ◽

Lemierre’S Syndrome ◽

Upper Respiratory ◽

Lemierre's Syndrome

Lemierre’s syndrome is also known as postangina septicemia, which is commonly caused byFusobacterium necrophorumalso known as Necrobacillus and also by other microorganisms likeStaphylococcus,Streptococcus,Peptostreptococcus, andBacteroides. Though the disease starts as an upper respiratory tract infection, it may spread and cause thrombophlebitis of the internal jugular vein. It may present itself through cranial nerve palsy or sepsis involving distant organs like the lungs or bones. It is also known as forgotten disease because of its rarity.Fusobacterium necrophorumusually causes infection in animals and rarely affects humans. We hereby present a case of Necrobacillus infection which did not cause any thrombophlebitis but resulted in severe pneumonia and acute kidney injury, leading to respiratory failure and requiring mechanical ventilation.

Download Full-text

Activation of the Contact System at the Surface of Fusobacterium necrophorum Represents a Possible Virulence Mechanism in Lemièrre's Syndrome

Infection and Immunity ◽

10.1128/iai.05264-11 ◽

2011 ◽

Vol 79 (8) ◽

pp. 3284-3290 ◽

Cited By ~ 19

Author(s):

Karin Holm ◽

Inga-Maria Frick ◽

Lars Björck ◽

Magnus Rasmussen

Keyword(s):

Specific Interaction ◽

Fusobacterium Necrophorum ◽

Pulmonary Involvement ◽

Surface Proteins ◽

Contact System ◽

Central Component ◽

Contact Activation ◽

Lemierre’S Syndrome ◽

Content Type ◽

Lemierre's Syndrome

ABSTRACTFusobacterium necrophorumcauses Lemièrre's syndrome, a serious disease with septic thrombophlebitis of the internal jugular vein, pulmonary involvement, and systemic inflammation. The contact system is a link between inflammation and coagulation, and contact activation by the bacteria could therefore contribute to the abnormal coagulation and inflammation seen in patients with Lemièrre's syndrome. In this study,F. necrophorumwas found to bind radiolabeled high-molecular-weight kininogen (HK), a central component of the contact system. Binding was inhibited by the addition of unlabeled HK and domain D5 of HK but not other components of the contact system, indicating a specific interaction mediated through the D5 region. Binding of HK was significantly reduced after pretreatment of the bacteria with trypsin, suggesting that surface proteins are involved in HK binding. Incubation of the bacteria with human plasma resulted in an HK breakdown pattern suggestive of bradykinin release, and bradykinin was also detected in the supernatant. In addition, we show that factor XI (FXI), another component of the contact system, binds toF. necrophorumand that the bound FXI reconstitutes the activated partial thromboplastin time of FXI-deficient plasma. Thrombin activity was detected at the surface of the bacteria following incubation with plasma, indicating that the intrinsic pathway of coagulation is activated at the surface. This activity was completely blocked by inhibitors of the contact system. The combined results show that the contact system is activated at the surface ofF. necrophorum, suggesting a pathogenic role for this system in Lemièrre's syndrome.

Download Full-text

Lemierre’s Syndrome: A Neglected Disease with Classical Features

Case Reports in Medicine ◽

10.1155/2015/846715 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Andreas V. Hadjinicolaou ◽

Yiannis Philippou

Keyword(s):

Jugular Vein ◽

Fusobacterium Necrophorum ◽

Blood Cultures ◽

Inotropic Support ◽

Lemierre’S Syndrome ◽

Jugular Vein Thrombosis ◽

Intensive Care Admission ◽

Vein Thrombosis ◽

History Of ◽

Lemierre's Syndrome

We report the case of a previously healthy, immunocompetent 23-year-old male who presented to the Emergency Department with general malaise, difficulty in breathing, fever, and chest pain. He reported a two-week history of progressively worsening sore throat that he presumed to be a viral infection and thus initially neglected. However, when his condition deteriorated, he was admitted to hospital acutely unwell and in respiratory distress. He quickly developed septic shock requiring intensive care admission for inotropic support. Ultrasound and CT imaging revealed internal jugular vein thrombosis with associated septic emboli reaching the lungs to form bilateral cavitations and consequently pleural effusions. Blood cultures were positive forFusobacterium necrophorum. Based on these findings, a diagnosis of Lemierre’s syndrome was made. The patient was treated with appropriate antibiotics and anticoagulation and gradually recovered. He was discharged 20 days after admission with advice to complete a six-week course of antibiotics.

Download Full-text