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.

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

2002 ◽  
Vol 81 (4) ◽  
pp. 234-252 ◽  
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.

scholarly journals Fusobacterium necrophorum Pharyngitis Complicated by Lemierre’s Syndrome

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Antonio Faraone ◽  
Alberto Fortini ◽  
Gabriele Nenci ◽  
Costanza Boccadori ◽  
Valerio Mangani ◽  
...  
Keyword(s):  
Clavulanic Acid ◽  
Fusobacterium Necrophorum ◽  
Uneventful Recovery ◽  
Lemierre’S Syndrome ◽  
Jugular Vein Thrombosis ◽  
Vein Thrombosis ◽  
History Of ◽  
Amoxicillin Clavulanic Acid ◽  
Bilateral Lung ◽  
Lemierre's Syndrome

We report the case of an 18-year-old woman who was referred to our outpatient clinic because of a 2-week history of sore throat, high fever, and neck tenderness unresponsive to a 7-day amoxicillin/clavulanic acid course. Infectious mononucleosis was initially suspected, but an extremely high value of procalcitonin and clinical deterioration suggested a bacterial sepsis, prompting the patient admission to our internal medicine ward. Blood cultures were positive for Fusobacterium necrophorum. CT scan detected a parapharyngeal abscess, a right internal jugular vein thrombosis, and multiple bilateral lung abscesses, suggesting the diagnosis of Lemierre’s syndrome. The patient was treated with a 2-week course of metronidazole and meropenem with a gradual clinical recovery. She was thereafter discharged home with metronidazole and amoxicillin/clavulanic acid for 14 days and a 3-month course of enoxaparin, experiencing an uneventful recovery. The present case highlights the importance of taking into consideration the Lemierre’s syndrome whenever a pharyngotonsillitis has a severe and unusual course.

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: a complication of acute oropharyngitis

2000 ◽  
Vol 114 (7) ◽  
pp. 545-547 ◽  
Author(s):  
R. Agarwal ◽  
P. S. Arunachalam ◽  
D. A. Bosman
Keyword(s):  
Case Report ◽  
Sore Throat ◽  
Cranial Nerve ◽  
Jugular Vein ◽  
Lemierre’S Syndrome ◽  
Jugular Vein Thrombosis ◽  
Vein Thrombosis ◽  
Cranial Nerve Palsies ◽  
Internal Jugular Vein Thrombosis ◽  
Lemierre's Syndrome

Lemierre’s syndrome is a recognized but infrequently seen complication of acute oropharyngitis. In this case report the patient presented with acute sore throat that led to a bacteraemia with internal jugular vein thrombosis and subsequent cranial nerve palsies.

scholarly journals Multiple Cranial Nerve Palsies in a Pediatric Case of Lemierre’s Syndrome due to Streptococcus viridans

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Samantha Novotny ◽  
Kenneth Serrano ◽  
Danielle Bazer ◽  
Louis Manganas
Keyword(s):  
Cavernous Sinus ◽  
Jugular Vein ◽  
Sinus Thrombosis ◽  
Streptococcus Viridans ◽  
Cavernous Sinus Thrombosis ◽  
Lemierre’S Syndrome ◽  
Jugular Vein Thrombosis ◽  
Vein Thrombosis ◽  
Internal Jugular Vein Thrombosis ◽  
Lemierre's Syndrome

Background. Lemierre’s syndrome is a rare condition of internal jugular vein thrombosis following oropharyngeal infection. While it usually results from Fusobacterium necrophorum infection, atypical cases associated with other pathogens have been reported. Objective. To describe a unique case of pediatric Lemierre’s syndrome with Streptococcus viridans infection resulting in cavernous sinus thrombosis and oculomotor, trochlear, and abducens nerve palsies. Case Report. A 14-year-old female initially presented after six days of fever, myalgias, and sore throat and was admitted for hyperbilirubinemia and acute kidney injury. She developed a fixed, dilated pupil with complete ophthalmoplegia, ptosis, and severe pain. Imaging revealed retromandibular space abscess, external and internal jugular vein thrombosis, cavernous sinus thrombosis, internal carotid artery stenosis, pulmonary embolism, and bilateral pneumonia. She was diagnosed with Lemierre’s syndrome with cultures positive for Streptococcus viridans and treated with a combination of antibiotics and anticoagulation. Conclusion and Relevance. Both antibiotics and anticoagulation were effective management for this Lemierre’s syndrome patient with cavernous sinus thrombosis. Early diagnosis and treatment of Lemierre’s syndrome is essential. A multidisciplinary treatment team is beneficial for managing the sequelae of this condition.

scholarly journals Unusual case of Lemierre’s syndrome

2018 ◽  
Vol 11 (1) ◽  
pp. e226948 ◽  
Author(s):  
Issrah I Jawad ◽  
Arjun Chandna ◽  
Stephen Morris-Jones ◽  
Sarah Logan
Keyword(s):  
Internal Jugular Vein ◽  
Unusual Case ◽  
Jugular Vein ◽  
Lemierre’S Syndrome ◽  
Jugular Vein Thrombosis ◽  
Vein Thrombosis ◽  
Campylobacter Rectus ◽  
Lemierre's Syndrome ◽  
Supportive Management ◽  
Rare Diagnosis

A young previously healthy patient presented with sepsis and cavitating pneumonia. Campylobacter rectus was isolated from blood cultures and subsequent CT neck showed an internal jugular vein thrombosis. Treatment was with antibiotics, anticoagulation and supportive management. Lemierre’s syndrome is an infectious thrombophlebitis of the internal jugular vein. Although a rare diagnosis since the use of penicillin for treatment of acute pharyngitis, it is being reported with increasing frequency. Usually associated with Fusobacterium spp, we believe that this is the first reported case of Lemierre’s caused by C. rectus—an anaerobic member of the human oral cavity flora, usually associated with localised periodontal disease. The bacillus was isolated from blood during the acute presentation.

scholarly journals Jugular vein thrombosis and anticoagulation therapy in Lemierre’s syndrome – a post-hoc observational and population-based study of 82 patients

2020 ◽  
Author(s):  
David Nygren ◽  
Johan Elf ◽  
Gustav Torisson ◽  
Karin Holm
Keyword(s):  
Jugular Vein ◽  
Anticoagulation Therapy ◽  
Population Based ◽  
Invasive Infection ◽  
Lemierre’S Syndrome ◽  
Jugular Vein Thrombosis ◽  
Septic Complications ◽  
Vein Thrombosis ◽  
Oropharyngeal Infection ◽  
Lemierre's Syndrome

Abstract Background Lemierre’s syndrome is typically caused by Fusobacterium necrophorum where an oropharyngeal infection is followed by septic internal jugular vein thrombophlebitis with subsequent septic embolization. Yet, the pathogenesis of septic thrombophlebitis, differences dependent on presence of jugular vein thrombosis and the role of anticoagulant therapy are insufficiently understood. Methods Patients with invasive infection with F. necrophorum and Lemierre’s syndrome who had been investigated for jugular vein thrombosis were included from a previous population-based observational study in Sweden. Medical records were reviewed and compared in patients with and without jugular vein thrombosis. Then, patients with jugular vein thrombosis were compared by exposure to therapeutic, prophylactic or no anticoagulation. Outcomes examined were thrombosis progression, early or late peripheral septic complications, chronic major sequelae, 30-day mortality and major bleeding. Results 51/82 (62%) radiologically investigated patients with Lemierre’s syndrome had jugular vein thrombosis. Patients with jugular vein thrombosis had lower platelet levels (median 76 vs 112 x10^9/L, p=0.04) on presentation and more days to defervesence (12 vs. 7 days, p=0.03), yet similar rates of major sequelae and 30-day-mortality. No significant differences in outcomes were seen between patients with jugular vein thrombosis exposed to therapeutic, prophylactic or no anticoagulation therapy, yet study outcomes were rare. Conclusion Patients with Lemierre’s syndrome with jugular vein thrombosis were more severely affected, yet had similar prognosis. Most patients with jugular vein thrombosis recovered well without therapeutic anticoagulation therapy, though adverse events were similarly rare in anticoagulated patients. The observational design and rarity of study outcomes requires cautious interpretation.

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