Lemierre’s disease: a typical presentation in two diabetic patients

<p>Lemierre disease (LD) is a rare but potentially life-threatening condition, characterized internal jugular vein suppurative thrombophlebitis and disseminated septic emboli following a recent oropharyngeal infection. It is seen commonly in healthy young adolescents or adults, caused by gram negative anerobic <em>Fusoform necropharum</em>. Lack of awareness of this condition delays treatment and worsens prognosis. We present two interesting cases of LD in diabetic patients, caused by <em>Klebsiella pneumonia</em> and <em>Haemophilus influenza</em> organisms at our hospital. Both patients had atypical presentations. Diagnosis of such atypical cases poses diagnostic and therapeutic challenges.</p>

Fusobacterium necrophorumsepsis after tonsillitis/pharyngitis

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.

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

Respiratory, head, and neck infections

This chapter covers the common cold, pharyngitis, retropharyngeal abscess, quinsy (peritonsillar abscess), Lemierre’s disease, croup, epiglottitis, bacterial tracheitis, laryngitis, sinusitis, mastoiditis, otitis externa, otitis media, dental infections, lateral pharyngeal abscess, acute bronchitis, chronic bronchitis, bronchiolitis, community-acquired pneumonia, aspiration pneumonia, hospital-acquired pneumonia, ventilator-associated pneumonia, pulmonary infiltrates with eosinophilia, empyema, lung abscess, cystic fibrosis, bronchiectasis, and pulmonary tuberculosis.