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

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
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.

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

Medicina ◽  
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.

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

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Catherine Rawes ◽  
Vanessa Badas ◽  
Kathryn Alyward ◽  
Annika Whittle ◽  
Peter Brown ◽  
...  
Keyword(s):  
Case Report ◽  
Venous Blood ◽  
Rare Condition ◽  
Early Warning Score ◽  
Mri Imaging ◽  
Lemierre’S Syndrome ◽  
Delay In Diagnosis ◽  
Increased Risk ◽  
Oropharyngeal Infection ◽  
Lemierre's Syndrome

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.

scholarly journals The Forgotten Disease: A Case of Lemierre’s Syndrome with Distal Extremity Involvement

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.

scholarly journals A Case of Lemierre Syndrome Secondary to Otitis Media and Mastoiditis

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
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.

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.

scholarly journals Fusobacterium necrophorumsepsis after tonsillitis/pharyngitis

2019 ◽  
Vol 12 (1) ◽  
pp. e222287 ◽  
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.

scholarly journals Lemierre's Syndrome – A rare cause of disseminated sepsis requiring multi-organ support

2017 ◽  
Vol 18 (4) ◽  
pp. 329-333 ◽  
Author(s):  
John Rae ◽  
Katie Misselbrook
Keyword(s):  
Intensive Care ◽  
Jugular Vein ◽  
Rare Complication ◽  
Rare Condition ◽  
Fusobacterium Necrophorum ◽  
Organ Support ◽  
Lemierre’S Syndrome ◽  
Systemic Sepsis ◽  
Lemierre's Syndrome ◽  
Care Support

Lemierre's syndrome is a rare complication of acute pharyngitis characterised by septicaemia with infective thrombophlebitis of the internal jugular vein, most commonly due to Fusobacterium necrophorum. It characteristically affects healthy young adults causing persistent pyrexia and systemic sepsis presenting several days after an initial pharyngitis. Septic emboli seed via the bloodstream to distant sites including the lung, joints, skin, liver, spleen and brain. Prolonged antimicrobial therapy is required and admission to intensive care common. This once rare condition is increasing in incidence but awareness amongst clinicians is low. We present a classic case in a young man who developed multi-organ failure requiring intensive care support and describe the epidemiology, pathophysiology, microbiology, clinical features and management of the disease.

scholarly journals Lemierre's syndrome: A calamitous complication of oropharyngeal infection

2019 ◽  
Vol 7 (2) ◽  
pp. 82
Author(s):  
Sourya Acharya ◽  
Roopesh Yarappa ◽  
Sakshi Gagneja ◽  
Shreya Gattani
Keyword(s):  
Lemierre’S Syndrome ◽  
Oropharyngeal Infection ◽  
Lemierre's Syndrome
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