Early Diagnosis and Antibiotic Treatment Combined with Multicomponent Hemodynamic Support for Addressing a Severe Case of Lemierre’s Syndrome

A 20-year-old man was admitted to the intensive care unit for septic shock due to Lemierre’s syndrome. It is a rare syndrome that manifests as an upper respiratory infection, although systemic involvement, severe coagulopathy, and multi-organ failure can dangerously complicate the clinical picture. In this syndrome, sepsis-related neuroendocrine dysregulation and microcirculation impairment can have a rapid deleterious progression. Consequently, proper diagnosis, early source control, and appropriate antibiotics administration are mandatory to improve the prognosis. The intensive treatment is aimed at limiting organ damage through hemodynamic optimization. Remarkably, in septic shock due to Lemierre’s syndrome, hemodynamic optimization can be achieved through the synergic effect of norepinephrine, argipressin, and hydrocortisone.

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Lemierre’s syndrome, necrotizing pneumonia and staphylococcal septic shock treated with extracorporeal life support

SAGE Open Medical Case Reports ◽

10.1177/2050313x17722726 ◽

2017 ◽

Vol 5 ◽

pp. 2050313X1772272

Author(s):

Adrian C Mattke ◽

Sudesh Prabhu ◽

Julia Clark ◽

Robert Labrom ◽

Hanna Burns ◽

...

Keyword(s):

Septic Shock ◽

Life Support ◽

Extracorporeal Life Support ◽

Source Control ◽

Necrotizing Pneumonia ◽

Lemierre’S Syndrome ◽

Vertebral Bodies ◽

Lemierre's Syndrome ◽

Prolonged Hospital

Objectives: Lemierre’s syndrome cause by methicillin-sensitive Staphylococcus aureus is rare, but can lead to necrotizing pneumonia and septicaemia. When treating such patient with extracorporeal life support source control can be both challenging and controversial. Methods: In this report we present a 12 year old male who presented with Lemierre’s syndrome from which he developed septic shock and severe necrotizing pneumonia. He also showed multiple pulmonary embolisms from the internal jugular vein thrombi, resulting in acute respiratory distress syndrome. Results: The patient was treated with extracorporeal life support. Subsequent computed tomography revealed multiple abscesses throughout his lungs and around vertebral bodies C1 and C2, for which source control with drainage of the cervical abscesses was achieved while on extracorporeal life support. The necrotizing pneumonia gradually improved, and partial pneumectomy was avoided. He was successfully separated from extracorporeal life support and respiratory support and recovered from his illness. Follow-up imaging showed almost complete resolution of the pulmonary abscesses. Osteomyelitis of C1/C2 and severe muscle wasting required a prolonged hospital stay. Conclusion: This case highlights the challenges of supporting patients suffering from disseminated staphylococcal sepsis with extracorporeal life support and the key role of source control and demonstrates the value of using extracorporeal life support in necrotizing pneumonia.

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LEMIERRE'S SYNDROME RESULTING IN SEPTIC SHOCK AND ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)

CHEST Journal ◽

10.1378/chest.136.4_meetingabstracts.12s-c ◽

2009 ◽

Vol 136 (4) ◽

pp. 12S

Author(s):

Joseph P. Mathew ◽

Samuel O. Acquah

Keyword(s):

Septic Shock ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Lemierre’S Syndrome ◽

Lemierre's Syndrome

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Lemierre's Syndrome with Septic Shock Caused by Fusobacterium Necrophorum

Anaesthesia and Intensive Care ◽

10.1177/0310057x0703500525 ◽

2007 ◽

Vol 35 (5) ◽

pp. 796-801 ◽

Cited By ~ 7

Author(s):

D. Wang ◽

A. K. Price ◽

K. K. Leitch ◽

M. Salvadori ◽

R. N. Singh ◽

...

Keyword(s):

Septic Shock ◽

Blood Culture ◽

Septic Arthritis ◽

Fusobacterium Necrophorum ◽

Abscess Formation ◽

Ankle Pain ◽

Lemierre’S Syndrome ◽

Surgical Interventions ◽

Obturator Internus ◽

Lemierre's Syndrome

Fusobacterium necrophorum infections are rare. We report a 15-year-old male who presented with tachycardia, nausea, vomiting, diarrhoea and ankle pain. He rapidly deteriorated requiring ventilation and vasopressors. Imaging of his thorax showed airspace consolidation, pulmonary cavitations and empyema. The ankle required drainage of purulent material. A thrombus in his internaljugular vein (Lemierre's syndrome) and an abscess in his obturator internus were subsequently found. Fusobacterium necrophorum was identified in blood culture on day nine. The patient recovered with antibiotics and surgical interventions for empyema and septic arthritis. Fusobacterium necrophorum should be a suspected pathogen in septic shock complicated by metastatic abscess formation.

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Atypical Presentation of Lemierre’s Syndrome Causing Septic Shock and Acute Respiratory Distress Syndrome

Case Reports in Infectious Diseases ◽

10.1155/2018/5469053 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Divyesh Reddy Nemakayala ◽

Manoj P Rai ◽

Shilpa Kavuturu ◽

Supratik Rayamajhi

Keyword(s):

Septic Shock ◽

Young Female ◽

Sudden Onset ◽

Lemierre’S Syndrome ◽

Oropharyngeal Infection ◽

Threatening Condition ◽

Life Threatening ◽

Chest X Ray ◽

Lemierre’S Disease ◽

Lemierre's Syndrome

Lemierre’s disease is a rare but life-threatening condition characterized by an oropharyngeal infection complicating with thrombophlebitis of the internal jugular vein and disseminated abscesses. We are presenting a case of a young female who initially presented with fevers, chills, sore throat, and swollen neck later developed progressively worsening shortness of breath along with sudden onset pleuritic chest pain. She then developed progressively worsening acute hypoxic respiratory failure requiring intubation and mechanical ventilation. Interval chest X-ray showed worsening bilateral effusions. She also developed septic shock requiring pressors. Blood culture showed Fusobacterium, and antibiotics were changed accordingly following which there was a clinical improvement. The diagnosis of Lemierre’s syndrome was then established based on her presenting age and bilateral pulmonary empyema in the setting of septicemia with Fusobacterium.

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A case of Lemierre's syndrome with septic shock and complicated parapneumonic effusions requiring intrapleural fibrinolysis

Respiratory Medicine Case Reports ◽

10.1016/j.rmcr.2015.08.007 ◽

2015 ◽

Vol 16 ◽

pp. 86-88 ◽

Cited By ~ 1

Author(s):

Daniel P. Croft ◽

Sean M. Philippo ◽

Paritosh Prasad

Keyword(s):

Septic Shock ◽

Lemierre’S Syndrome ◽

Lemierre's Syndrome

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

British Journal of Surgery ◽

10.1093/bjs/znab259.335 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

G Aruede ◽

S Ananth ◽

S Mustafa ◽

JM Soukias

Keyword(s):

Pulmonary Nodules ◽

Severe Case ◽

Fusobacterium Necrophorum ◽

Filling Defect ◽

Neck Mass ◽

Peritonsillar Abscess ◽

Lemierre’S Syndrome ◽

Lemierre's Syndrome ◽

High Index Of Suspicion ◽

Conclusive Diagnosis

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.

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A case of septic arthritis of the temporomandibular joint with necrotic peri-articular infection and Lemierre’s syndrome: an unusual presentation

Oral and Maxillofacial Surgery ◽

10.1007/s10006-020-00921-z ◽

2020 ◽

Author(s):

Mats Døving ◽

Erik Egeland Christensen ◽

Lars Peder Huse ◽

Øystein Vengen

Keyword(s):

Septic Shock ◽

Case Report ◽

Septic Arthritis ◽

Temporomandibular Joint ◽

Pathological Fracture ◽

Case Reports ◽

Mandibular Condyle ◽

Unusual Presentation ◽

Lemierre’S Syndrome ◽

Lemierre's Syndrome

Abstract Background Septic arthritis of the temporomandibular joint (TMJ) is rare. It usually causes isolated, locoregional symptoms related to the infected intra-articular space but may also cause fever and malaise. Case report We present a case of a 72-year-old male with septic arthritis of the TMJ complicated by extensive peri-articular necrosis, septic shock, cerebral abscess, Lemierre’s syndrome, and a pathological fracture of the mandibular condyle. Conclusion Case reports describing such a severe course of the disease are few. Moreover, this is the first report of septic arthritis of the TMJ to cause Lemierre’s syndrome.

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Septic shock Fusobacterium necrophorum from origin gynecological at complicated an acute respiratory distress syndrome: a variant of Lemierre's syndrome

Annales de biologie clinique ◽

10.1684/abc.2011.0538 ◽

2011 ◽

Vol 69 (2) ◽

pp. 202-207

Author(s):

Sophie Huynh-Moynot ◽

Diane Commandeur ◽

Marc Danguy Des Deserts ◽

Isabelle Drouillard ◽

Patrick Leguen ◽

...

Keyword(s):

Septic Shock ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Fusobacterium Necrophorum ◽

Lemierre’S Syndrome ◽

Lemierre's Syndrome

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Metagenome of Covid19 patient from Bangladesh corroborates the anaerobic colonization enabled by SAR-Cov2 with a novel, hard to culture, bacteria - Lawsonella clevelandensis - that is implicated in disease by causing abscesses

10.31219/osf.io/xtb7v ◽

2020 ◽

Author(s):

Sandeep Chakraborty

Keyword(s):

Septic Shock ◽

Epstein Barr Virus ◽

Jugular Vein ◽

Bacterial Load ◽

Anaerobic Bacteria ◽

Lemierre’S Syndrome ◽

Barr Virus ◽

Blood Clots ◽

Epstein Barr ◽

Lemierre's Syndrome

I have hypothesized [1] that SARS-Cov2 [2,3] enables anaerobic bacteria (Prevotella, et al) to colonize the lungs disrupting homeostasis. This finds resonance in the ‘forgotten disease’ Lemierre’s Syndrome [4–9,9,10], caused by anaerobic bacteria enabled by Epstein Barr Virus [11, 12]. Common symptoms include ARDS, septic shock, blood clots and arterial stroke [?,13–17]. A key difference is that Lemierre’s Syndrome originates in the jugular vein, while Covid19 starts from the lungs (possibly making it easier to treat).Here, metagenome from a Covid19 patient in Bangladesh Accid:PRJNA633241) is analyzed (Table 1). While, bacterial load is low (and this might be due to removal of reads), it corroborates the anaerobic domination with a novel anaerobic bacteria - Lawsonella clevelandensis - being implicated.

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