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

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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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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A Case of Lemierre Syndrome Secondary to Otitis Media and Mastoiditis

Case Reports in Emergency Medicine ◽

10.1155/2014/208960 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Aynur Turan ◽

Harun Cam ◽

Yeliz Dadali ◽

Serdar Korkmaz ◽

Ali Özdek ◽

...

Keyword(s):

Otitis Media ◽

Internal Jugular Vein ◽

Jugular Vein ◽

Anaerobic Bacteria ◽

Transverse Sinus ◽

Lemierre’S Syndrome ◽

Lemierre Syndrome ◽

Mortality And Morbidity ◽

Oropharyngeal Infection ◽

Lemierre's Syndrome

Lemierre’s syndrome is a rare clinical condition that generally develops secondary to oropharyngeal infection caused byFusobacterium necrophorum, which is an anaerobic bacteria. A 62-year-old patient with diabetes mellitus presented with internal jugular vein and sigmoid sinus-transverse sinus thrombophlebitis, accompanying otitis media and mastoiditis that developed after an upper airway infection. Interestingly, there were air bubbles in both the internal jugular vein and transverse sinus. Vancomycin and meropenem were started and a right radical mastoidectomy was performed. The patient’s clinical picture completely resolved in 14 days. High mortality and morbidity may be prevented with a prompt diagnosis of Lemierre’s syndrome.

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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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A rare, but life-threatening sore throat: A case of Lemierre’s syndrome

Acute Medicine Journal ◽

10.52964/amja.0844 ◽

2021 ◽

Vol 20 (1) ◽

pp. 78-82

Author(s):

A McCleane ◽

◽

M Hunter ◽

PC Johnston ◽

M Trimble ◽

...

Keyword(s):

Sore Throat ◽

Fusobacterium Necrophorum ◽

Lung Abscess ◽

Lemierre’S Syndrome ◽

Blood Tests ◽

Threatening Condition ◽

Life Threatening ◽

Lemierre's Syndrome ◽

Initial Blood ◽

Electrolyte Abnormalities

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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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.

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Lemierre’s Syndrome Associated with Mechanical Ventilation and Profound Deafness

Case Reports in Infectious Diseases ◽

10.1155/2017/4261429 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

Lukas Birkner

Keyword(s):

Mechanical Ventilation ◽

Cochlear Implant ◽

Jugular Vein ◽

Lemierre’S Syndrome ◽

Oropharyngeal Infection ◽

Profound Deafness ◽

Ventilation Support ◽

Mechanical Ventilation Support ◽

Life Threatening ◽

Lemierre's Syndrome

Lemierre’s syndrome is a rare disorder that is characterized by anaerobic organisms inducing a thrombophlebitis of the internal jugular vein (IJV) following a course of oropharyngeal infection. It often occurs in young and healthy patients. Clinicians continuously misinterpret early symptoms until infection disseminates systematically and life-threatening sepsis transpires. We report the case of a 58-year-old female developing Lemierre’s syndrome accompanied by invasive ventilation support and a profound deafness requiring the implementation of a cochlear implant. This is one of two reported cases of Lemierre’s syndrome associated with mechanical ventilation support and the only case associated with a cochlear implant.

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Abdominal variant of Lemierre’s Syndrome in a Patient with Pancreatic Adenocarcinoma

Medeniyet Medical Journal ◽

10.5222/mmj.2021.17992 ◽

2021 ◽

Author(s):

Yavuz Furuncuoğlu ◽

Bala Başak Oven ◽

Başak Mert ◽

Enis Çağatay Yılmaz ◽

Mustafa Kemal Demir

Keyword(s):

Jugular Vein ◽

Fusobacterium Necrophorum ◽

Infectious Agents ◽

Resonance Imaging ◽

Lemierre’S Syndrome ◽

Gastrointestinal Malignancies ◽

Life Threatening ◽

Weighted Magnetic Resonance Imaging ◽

Magnetic Resonance Imaging Mri ◽

Lemierre's Syndrome

Lemierre’s syndrome is an illness characterized by internal jugular vein thrombophlebitis related to infectious agents, primarily Fusobacterium necrophorum. These bacteria, residing in both the oropharynx and the gastrointestinal tract, may lead to pylephlebitis, a serious condition that could result in the development of hepatic abscesses. This manifestation of the disease is regarded as the abdominal variant of Lemierre’s syndrome. Patients with gastrointestinal malignancies, especially those who undergo surgeries, are susceptible to the abdominal variant of Lemierre’s syndrome. Timely diagnosis is required to avoid the life-threatening complications of the abdominal variant of Lemierre’s syndrome. Diffusion-weighted magnetic resonance imaging (MRI) might be very useful in differentiating this disease from liver metastasis in patients with malignancies. Radiologists and clinicians need to be aware of this challenging condition to prevent misdiagnosis, since prompt treatment is often lifesaving.

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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.

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Bilateral Lemierre's Syndrome: A Case Report and Literature Review

Ear Nose & Throat Journal ◽

10.1177/014556130208100412 ◽

2002 ◽

Vol 81 (4) ◽

pp. 234-252 ◽

Cited By ~ 37

Author(s):

Brian A. Moore ◽

Catherine Dekle ◽

Jay Werkhaven

Keyword(s):

Internal Jugular Vein ◽

Jugular Vein ◽

Fusobacterium Necrophorum ◽

Lemierre’S Syndrome ◽

Jugular Vein Thrombosis ◽

Jugular Veins ◽

Vein Thrombosis ◽

Warfarin Sodium ◽

Oropharyngeal Infection ◽

Lemierre's Syndrome

Lemierre's syndrome is characterized by thrombosis of the internal jugular vein that develops following an oropharyngeal infection. Sepsis and septic metastases frequently ensue and affect the lungs, the musculoskeletal system, and occasionally the liver. Most cases are caused by infection with Fusobacterium necrophorum. This infection responds to antibiotic therapy with beta-lactamase-resistant compounds that exert good anaerobic coverage. Anticoagulation and surgical intervention can be helpful in advanced cases. Fewer than 160 cases of classic Lemierre's syndrome have been described; approximately one-third of these reported cases have occurred since 1988. We describe a new case of Lemierre's syndrome that occurred in an otherwise healthy 27-year-old man. Thrombosis of both internal jugular veins extended through the subclavian system and into both upper extremities. The patient was treated with intravenous antibiotics and heparin during 14 days of hospitalization. He was discharged on oral clindamycin and warfarin sodium, and after 6 months he was able to return to full activity. To our knowledge, this is the first reported case of Lemierre's syndrome in which internal jugular vein thrombosis occurred bilaterally. By reporting this previously undescribed manifestation of Lemierre's syndrome, we hope to increase practitioner awareness of this disease entity.

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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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