Lemierre’s syndrome in an intravenous drug user

2020 ◽  
Vol 13 (7) ◽  
pp. e235390
Author(s):  
Daniel Fernandez ◽  
Mirza Ahmad ◽  
Gary Decker ◽  
Mark M Aloysius
Keyword(s):  
Jugular Vein ◽  
Intravenous Drug User ◽  
Blood Cultures ◽  
Pleuritic Chest Pain ◽  
Lemierre’S Syndrome ◽  
Heroin Use ◽  
History Of ◽  
The Right ◽  
Lemierre's Syndrome ◽  
Scleral Icterus

A 29-year-old Dominican man with a history of intravenous heroin use and hepatitis C presented with a 5-day history of fever, dyspnoea, haemoptysis, pleuritic chest pain, abdominal pain, haematochezia and haematemesis. Initial physical examination was significant for scleral icterus, generalised abdominal tenderness to palpation, melaena and blood-tinged sputum. Blood cultures grew Fusobacterium species. CT scan of the chest revealed multiple bilateral cavitary features in lung fields. At the same time, a neck ultrasound performed demonstrated thrombophlebitis in the right internal jugular vein, confirming the diagnosis of ‘Lemierre’s syndrome’. Treatment was with antibiotics and supportive care for 6 weeks.

scholarly journals Lemierre’s Syndrome: A Neglected Disease with Classical Features

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
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.

scholarly journals Lemierre’s Syndrome: A Complication of Cervicofacial Cellulitis in a Child

2021 ◽  
pp. 1-3
Author(s):  
Mohamed Ali GLITI ◽  
◽  
Lina EL Messaoudi ◽  
Sophia Nitassi ◽  
Bencheikh Razika ◽  
...  
Keyword(s):  
Jugular Vein ◽  
Chest Ct ◽  
Blood Cultures ◽  
Septic Thrombophlebitis ◽  
Lemierre’S Syndrome ◽  
Pediatric Case ◽  
Lemierre Syndrome ◽  
Oropharyngeal Infection ◽  
The Right ◽  
Lemierre's Syndrome

Introduction: Lemierre’s syndrome complicates oropharyngeal infection and associates septic thrombophlebitis of the internal jugular vein with sepsis and distant septic emboli (especially pulmonary). We report a pediatric case with thrombophlebitis of the jugular vein in the context of cervicofacial cellulitis. Summary of the Clinical Case: A 2-year-old girl consulted in the emergency room for angina complicated by right cervicofacial cellulitis with thrombosis of the right jugular vein. The diagnosis of atypical Lemierre syndrome was made and the patient received first medical treatment (antibiotic therapy, anticoagulation) allowing a cure without sequelae. And secondary surgical treatment (adenoidectomy and tonsillectomy). Discussion: The presence of a cervical venous thrombosis complicating an oropharyngeal infection should lead to a search for Lemierre’s syndrome (blood cultures and chest CT) rare but serious and require immediate treatment

scholarly journals Tricuspid valve infective endocarditis in a non-IVDU patient with atopic dermatitis

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Heerani Woodun ◽  
Sarah Bouayyad ◽  
Sura Sahib ◽  
Nadir Elamin ◽  
Steven Hunter ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Infective Endocarditis ◽  
Tricuspid Valve ◽  
Intravenous Drug User ◽  
Blood Cultures ◽  
Topical Steroids ◽  
Foramen Ovale ◽  
History Of ◽  
The Right ◽  
Systemic Infections

Abstract A 29-year-old male, with chronic atopic dermatitis (AD), presented with a 2-week history of fatigue, pyrexia and weight loss. Examination showed eczematous patches with lichenified papules, erosions on the right shin and a new murmur. Blood cultures isolated methicillin-sensitive Staphylococcus aureus. Transthoracic echocardiography showed vegetation on the tricuspid valve (TV) that was adherent to the septal leaflet. He was treated for infective endocarditis, attributed to poorly controlled AD, with intravenous Flucloxacillin. Due to ongoing sepsis and pulmonary septic emboli, Clindamycin was added. He underwent TV repair; the septal leaflet was excised, and the remnant two leaflets were brought together with a ring. His patent foramen ovale was closed. His skin was treated with topical steroids and emollients. Right-sided endocarditis of an intact TV is uncommon in a non-intravenous drug user. Therefore, this novel case portrays the importance of aggressively managing AD as it is a risk factor for significant systemic infections.

scholarly journals The challenges of a Lemierre’s syndrome in COVID-19 times

2020 ◽  
Vol 6 (12) ◽  
pp. 2299
Author(s):  
Vikram Kemmannu Bhat ◽  
Jino Johns Lalitha ◽  
Suhas Suresh Desai ◽  
Nidhi Mohan Sreedevi
Keyword(s):  
Jugular Vein ◽  
Subcutaneous Tissue ◽  
Bone Marrow Suppression ◽  
High Morbidity ◽  
Lemierre’S Syndrome ◽  
Chest Computed Tomography ◽  
Life Threatening ◽  
The Right ◽  
Lemierre's Syndrome ◽  
High Index Of Suspicion

<p>Lemierre’s syndrome is a type of necrotizing fasciitis of the head and neck that is an uncommon rapidly spreading infection involving the skin, subcutaneous tissue and the fascia leading to life-threatening complications like septicaemia, bone marrow suppression, disseminated intravascular coagulation and multi-organ failure. The management of this disease, especially in COVID-19 pandemic is a challenge as it is associated with high morbidity. A 46-year-old male presented to us with complaints of swelling in the neck with discoloration of skin in the neck and chest. Computed tomography (CT) scan of the neck revealed thrombosis of the right internal jugular vein (IJV) and diffuse abscesses on both sides of the neck. A high index of suspicion is required for the diagnosis of Lemierre’s syndrome in the absence of typical clinical features. The rapid, unpredictable dissemination of infection and occult thrombus within the IJV make both diagnosis and management a challenge especially, during COVID-19 times.</p>

scholarly journals A unique case of Lemierre’s syndrome status post blunt cervical trauma

Vascular ◽  
2020 ◽  
Vol 28 (4) ◽  
pp. 485-488
Author(s):  
John M Denesopolis ◽  
Ratna C Medicherla Singh ◽  
Amit R Shah ◽  
Ross Lyon ◽  
Edward Chao ◽  
...  
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Blood Cultures ◽  
Left Internal Jugular Vein ◽  
Lemierre’S Syndrome ◽  
Cervical Trauma ◽  
Jugular Vein Thrombosis ◽  
Vein Thrombosis ◽  
Left Neck ◽  
Lemierre's Syndrome

Background Lemierre’s syndrome is a rare but potentially fatal condition. The course is characterized by acute tonsillopharyngitis, bacteremia, internal jugular vein thrombosis, and septic embolization. There have been some cases secondary to penetrating trauma to the neck. Literature review has yielded no cases secondary to blunt neck trauma in the absence of oropharyngeal injury. We aim to shed light on this unique cause of Lemierre’s syndrome, so as to raise the index of suspicion for clinicians working up patients with blunt cervical trauma. Methods We present a case of a 25-year-old male restrained driver who presented with left neck and shoulder pain with a superficial abrasion to the left neck from the seatbelt who was discharged same day by the Emergency Room physicians. He returned to the Emergency Department two days later with abdominal pain. As a part of his repeat evaluation, a set of blood cultures were sent and was sent home that day. The patient was called back to the hospital one day later as preliminary blood cultures were positive for Gram positive cocci and Gram negative anaerobes. Computerized tomography scan of the neck revealed extensive occlusive left internal jugular vein thrombosis and fluid collections concerning for abscesses, concerning for septic thrombophlebitis. The patient continued to decompensate, developing severe sepsis complicated by disseminated intravascular coagulation. Results The patient underwent a left neck exploration with en bloc resection of the left internal jugular vein, drainage of abscesses deep to the sternocleidomastoid, and washout/debridement of necrotic tissue. Direct laryngoscopy at the time of surgery revealed no injury to the aerodigestive tract. Wound cultures were consistent with blood cultures and grew Fusobacterium necrophorum, Staphylococcus epidermidis, and Methicillin-resistant staphylococcus aureus. The patient underwent two subsequent operative wound explorations without any evidence of residual infection. The patient was discharged home on postoperative day 13 on a course of antibiotics and aspirin. Conclusion This case illustrates the importance of diagnosis of Lemierre’s syndrome after an unconventional inciting event (blunt cervical trauma) and appropriate treatment.

Lemierre’s Syndrome

1970 ◽  
Vol 9 (2) ◽  
Author(s):  
Pearl Behl MD ◽  
Phillip Wattam MD
Keyword(s):  
Blood Count ◽  
Complete Blood Count ◽  
Jugular Vein ◽  
Blood Cultures ◽  
Surgical Drainage ◽  
Computed Tomography Scan ◽  
Intermittent Fever ◽  
History Of ◽  
The Right ◽  
Tomography Scan

A 67-year-old immunocompetent female with a history of recurrent parotiditis developed swelling of the right side of her neck and face, intermittent fever, dyspnea, and dysphagia. Her complete blood count revealed a neutrophilic leukocytosis. Blood cultures grew Staphylococcus aureus. A computed tomography scan showed right-sided facial and neck edema, and a thrombus in the right internal jugular vein (Figure 1). A prolonged course of antibiotic therapy was initiated. In some cases, surgical drainage of any abscesses, ligation of thrombosed vessels, and anticoagulation may be required.

scholarly journals Septic Thrombophlebitis Caused byFusobacterium necrophorumin an Intravenous Drug User

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
D. Dimitropoulou ◽  
M. Lagadinou ◽  
T. Papayiannis ◽  
V. Siabi ◽  
C. A. Gogos ◽  
...  
Keyword(s):  
Drug Users ◽  
Intravenous Drug User ◽  
Fusobacterium Necrophorum ◽  
Intravenous Drug ◽  
Causative Organism ◽  
Septic Thrombophlebitis ◽  
Lemierre’S Syndrome ◽  
Indwelling Catheters ◽  
History Of ◽  
Lemierre's Syndrome

Septic thrombophlebitis is characterized by venous thrombosis, inflammation and bacteremia, that can lead to fatal complications such as sepsis, septic emboli and even death. Though most commonly caused by indwelling catheters, it is also related to intravenous drug users (IVDU) especially those who attempt to inject drugs into more proximal and central veins. Lemierre’s syndrome, also referred to as post-anginal sepsis or necrobacillosis, is a suppurative thrombophlebitis of the internal jugular vein. Primary infection is associated with oropharyngeal and dental infections and the most common causative organism isFusobacterium necrophorum. We report a case of Lemierre’s syndrome in an IVDU, caused byFusobacterium necrophorum, which was inoculated at the site of injection, without a history of sore throat or pharyngitis.

Lemierre’s syndrome as a consequence of acute supraglottitis

2002 ◽  
Vol 116 (3) ◽  
pp. 216-218 ◽  
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.

scholarly journals Acute neck pain referred to the surgeon: Lemierre's syndrome as a differential diagnosis

2012 ◽  
Vol 94 (3) ◽  
pp. e132-e133 ◽  
Author(s):  
D Chattopadhyay ◽  
ML Mostafa ◽  
M Carr
Keyword(s):  
Pulmonary Embolism ◽  
Differential Diagnosis ◽  
Neck Pain ◽  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Lemierre’S Syndrome ◽  
Lemierre's Syndrome ◽  
Acute Neck Pain

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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