EP.FRI.147 Abdominal Variant Lemierre’s Syndrome: A Case Study and literature review

Abstract Background Lemierre’s Syndrome (LS) is a rare condition with a prevalence of around 0.6-2.3 cases per million of population. Typically, LS starts with a Fusobacterium Necophorum oropharyngeal infection which spreads rapidly causing infective thrombophlebitis, classically of the internal jugular. This is a life-threatening condition which left untreated has a mortality of 90%. In less than 10% of LS cases thrombophlebitis occurs outside of the internal jugular vein. These atypical presentations can result in delay in diagnosis thus treatment and hence have an increased risk of mortality. Case Report Here we present a case report of a patient with Abdominal Variant Lemierre’s syndrome. A 47-year-old female with no past medical history was admitted to the emergency department with severe epigastric abdominal pain. The patient was stable, her National Early Warning Score (NEWS) was 2, blood tests on admission showed thrombocytopenia (Hb 121g/dl, Platelets 50x109/l, WCC 17.1x1012/l), raised CRP 299mg/l and deranged Liver Function Tests (Total protein 56g/l, Bilirubin 45mg/dl, ALT 94U/L, AlkPhos- 121U/L). A Venous Blood Gas was abnormal with Lactate 2.1mmol/l. A sepsis pathway was initiated. The blood cultures grew Fusobacterium Necophorum. MRI Imaging confirmed the diagnosis of Abdominal Variant Lemierre’s Syndrome. Haematology and Microbiology were consulted. The patient was treated with antibiotics and anticoagulation and was discharged 29 days later, she has made a full recovery. Conclusion This case highlights the importance of sepsis vigilance in Acute General Surgery admissions and emphasises that multidisciplinary teamwork is essential to achieve effective and prompt treatment for patients.

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Lemierre’s Syndrome: Recognising a Typical Presentation of a Rare Condition

Case Reports in Infectious Diseases ◽

10.1155/2015/797415 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

James A. Coultas ◽

Neena Bodasing ◽

Paul Horrocks ◽

Anthony Cadwgan

Keyword(s):

Rare Complication ◽

Anaerobic Bacteria ◽

Anticoagulation Therapy ◽

Rare Condition ◽

Signs And Symptoms ◽

Positive Outcome ◽

Lemierre’S Syndrome ◽

Delay In Diagnosis ◽

Oropharyngeal Infection ◽

Lemierre's Syndrome

Lemierre’s syndrome is a rare complication following an acute oropharyngeal infection. The aetiological agent is typically anaerobic bacteria of the genusFusobacterium. The syndrome is characterised by a primary oropharyngeal infection followed by metastatic spread and suppurative thrombophlebitis of the internal jugular vein. If left untreated, Lemierre’s syndrome carries a mortality rate of over 90%. Whilst relatively common in the preantibiotic era, the number of cases of Lemierre’s syndrome subsequently declined with the introduction of antibiotics. With the increase of antibiotic resistance and a greater reluctance to prescribe antibiotics for minor conditions such as tonsillitis, there are now concerns developing about the reemergence of the condition. This increasing prevalence in the face of an unfamiliarity of clinicians with the classical features of this “forgotten disease” may result in the misdiagnosis or delay in diagnosis of this potentially fatal illness. This case report illustrates the delay in diagnosis of probable Lemierre’s syndrome in a 17-year-old female, its diagnosis, and successful treatment which included the use of anticoagulation therapy. Whilst there was a positive outcome, the case highlights the need for a suspicion of this rare condition when presented with distinctive signs and symptoms.

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Lemierre's syndrome: suppurative thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection – An overview and case report of surgical management

British Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.bjoms.2016.11.186 ◽

2016 ◽

Vol 54 (10) ◽

pp. e131-e132 ◽

Cited By ~ 1

Author(s):

James Sloane ◽

Clifton Wan ◽

Peyman Alam

Keyword(s):

Case Report ◽

Internal Jugular Vein ◽

Surgical Management ◽

Jugular Vein ◽

Lemierre’S Syndrome ◽

Oropharyngeal Infection ◽

Lemierre's Syndrome

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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.

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Lemierre's Syndrome Complicating Pregnancy

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2007/68084 ◽

2007 ◽

Vol 2007 ◽

pp. 1-3 ◽

Cited By ~ 7

Author(s):

M. Thompson ◽

A. O. Awonuga ◽

J. Bell ◽

C. Ray ◽

M. T. Awonuga ◽

...

Keyword(s):

Case Report ◽

Jugular Vein ◽

Premature Delivery ◽

Second Trimester ◽

Neurological Damage ◽

Lemierre’S Syndrome ◽

Atypical Case ◽

Oropharyngeal Infection ◽

Lemierre's Syndrome ◽

In Pregnancy

Lemierre's syndrome is an anaerobic suppurative thrombophlebitis involving the internal jugular vein secondary to oropharyngeal infection. There is only one previous case report in pregnancy which was complicated by premature delivery of an infant that suffered significant neurological damage. We present an atypical case diagnosed in the second trimester with a live birth at term. By reporting this case, we hope to increase the awareness of obstetricians to the possibility of Lemierre's syndrome when patients present with signs of unabating oropharyngeal infection and pulmonary symptoms.

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Lemierre's Syndrome in a Patient with Severe Lupus Nephritis

Journal of Nepal Medical Association ◽

10.31729/jnma.37 ◽

2011 ◽

Vol 51 (183) ◽

Cited By ~ 2

Author(s):

B P Paudyal

Keyword(s):

Lupus Nephritis ◽

Host Response ◽

Jugular Vein ◽

Immunocompromised Patients ◽

Lemierre’S Syndrome ◽

Increased Risk ◽

Oropharyngeal Infection ◽

Severe Lupus Nephritis ◽

Immunocompromised State ◽

Lemierre's Syndrome

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. Keywords: Lemierre’s syndrome, lupus nephritis, immunocompromised state

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Lemierre’s Syndrome: Case Presentation of a Rare and Possibly Life-Threatening Condition

Medicina ◽

10.3390/medicina57101102 ◽

2021 ◽

Vol 57 (10) ◽

pp. 1102

Author(s):

Lucian Giubelan ◽

Livia Dragonu ◽

Vlad Pădureanu ◽

Alexandru Neacșu ◽

Mirela Mănescu ◽

...

Keyword(s):

Jugular Vein ◽

Anaerobic Bacteria ◽

Rare Condition ◽

Fusobacterium Necrophorum ◽

Lemierre’S Syndrome ◽

Case Presentation ◽

Oropharyngeal Infection ◽

Threatening Condition ◽

Life Threatening ◽

Lemierre's Syndrome

Lemierre’s syndrome is, presently, a very rare condition, but a life-threatening one. The syndrome was first described in 1936 by Andre Lemierre and comprises an oropharyngeal infection (most commonly associated with anaerobic bacteria Fusobacterium necrophorum), internal jugular vein thrombophlebitis and, possibly, secondary septic metastasis (common sites are lungs or brain). We describe such a rare case diagnosed at our Infectious Diseases Department in September 2019.

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Fusobacterium necrophorumsepsis after tonsillitis/pharyngitis

BMJ Case Reports ◽

10.1136/bcr-2017-222287 ◽

2019 ◽

Vol 12 (1) ◽

pp. e222287 ◽

Cited By ~ 2

Author(s):

Micheal Sheehan ◽

Darren McLoughlin ◽

Ronan O’Sullivan

Keyword(s):

Early Recognition ◽

Rare Condition ◽

Fusobacterium Necrophorum ◽

Adverse Outcomes ◽

Lemierre’S Syndrome ◽

Metastatic Focus ◽

Oropharyngeal Infection ◽

History Of ◽

Lemierre’S Disease ◽

Lemierre's Syndrome

Fusobacterium necrophorumis a rare infection most notable for causing Lemierre’s syndrome. This consists of a primary oropharyngeal infection and septic thrombophlebitis, and one or more metastatic focus. Prior to the widespread use of antibiotics, Lemierre’s syndrome commonly followed a rapidly progressing course, with a high mortality. We describe a case of a previously well 18-month-old boy who presented to the emergency department with a 3-week history of progressive, right-sided, painful neck swelling and systemic sepsis. He was initially treated conservatively with intravenous antibiotics, but ultimately required surgical drainage. Lemierre’s syndrome is a rare condition with increasing incidence which can have significant adverse outcomes including death. Early recognition and treatment are essential, but identifying Lemierre’s disease is challenging.

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