A Case of Lemierre's Syndrome in Association with Liver Abscess without Any Other Metastatic Lesions

Iwasaki, Takanori; Yamamoto, Takashi; Inoue, Ken‐ichiro; Takaku, Kenichi

doi:10.2169/internalmedicine.51.7364

Cited by 19 publications

(9 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A few (n=2) patients suffered from side effects (hemorrhage or disseminated intravascular coagulation) and were treated accordingly without serious adverse effects. 32 , 87 In the review by Riordan and also previous reviews, the frequency of patients treated with anticoagulants was 21%–23%. The high prevalence in this study might be due to the widespread, unconfirmed hypothesis regarding the positive effects of anticoagulants, which seem to have gained a favorable position in the clinic.…”

Section: Managementmentioning

confidence: 89%

See 1 more Smart Citation

Lemierre’s syndrome: current perspectives on diagnosis and management

Johannesen

Bødtger

2016

IDR

159

160

View full text Add to dashboard Cite

This is a systematic review of cases with Lemierre’s syndrome (LS) in the past 5 years. LS is characterized by sepsis often evolving after a sore throat or tonsillitis and then complicated by various septic emboli and thrombosis of the internal jugular vein. Symptoms include sepsis, pain, and/or swelling in the throat or neck, as well as respiratory symptoms. Laboratory findings show elevated infectious parameters and radiological findings show thrombosis of the internal jugular vein and emboli in the lungs or other organs. The syndrome is often associated with an infection with Fusobacterium necrophorum. We found a total of 137 cases of LS, of which 47 were infected with F. necrophorum and others with Staphylococcus and Streptococcus. Complications of this rare but severe disease included osteomyelitis, meningitis, and acute respiratory distress syndrome. Mortality was extremely high in the pre-antibiotic era but has diminished with the advent of antibiotics. This review showed a mortality rate of only 2% of which none of the cases involved fusobacteria. Duration of treatment varied; a 4–6-week course of carbapenem or piperacillin/tazobactam in combination with metronidazole was optimum. Other treatment options included anticoagulants in 46% of cases, which is unwarrantedly high, as to date, no evidence of the positive effects of anticoagulants in LS exists. Only two cases had ligation of the internal jugular vein performed. This review confirms the rare, but severe aspects of LS. Mortality from LS in this day and age appears to be low, however the syndrome is difficult to recognize, and still requires the full attention of the clinician.

show abstract

Section: Managementmentioning

confidence: 89%

“…A larger proportion of cases (71 cases) had septic emboli in the lungs, but septic emboli were also seen in other organs, such as the liver, 12 , 38 , 87 spleen, 81 joints, 38 , 70 heart, 38 and the central nervous system, 29 , 31 even though in smaller numbers.…”

Section: Diagnosismentioning

confidence: 99%

Lemierre’s syndrome: current perspectives on diagnosis and management

Johannesen

Bødtger

2016

IDR

159

160

View full text Add to dashboard Cite

show abstract

“…Iwasaki et al . [ 4 ] reviewed 13 cases of LS complicated by liver abscesses. Patients were generally young, with a mean age of 21.7 years.…”

Section: Discussionmentioning

confidence: 99%

“…However, caution must be exercised when selecting antibiotics for the treatment of LS, as Fusobacterium necrophorum exhibits resistance as high as 22% to 60% against penicillin and macrolides [ 5 ]. Iwasaki et al reported treating a case of LS accompanied by a liver abscess with a single agent (carbapenem) [ 4 ]. In addition, antibiotic administration treatment periods of various lengths have been reported across cases, with a range of 2 to 12 weeks.…”

Section: Discussionmentioning

confidence: 99%

Liver abscessation and multiple septic pulmonary emboli associated with Lemierre’s syndrome: a case report

et al. 2015

View full text Add to dashboard Cite

BackgroundIn Lemierre’s syndrome, patients first exhibit pharyngitis and peritonsillar abscessation, followed by the development of anaerobic bacterial (usually Fusobacterium necrophorum) septicemia and metastatic infections throughout the body. However, these infections rarely affect the liver. We describe a case of Lemierre’s syndrome, in which the first disease manifestation was liver abscess, for drawing attention of emergency physicians to this rare but fatal disease.Case presentationA 28-year-old Asian ethnicity Filipino male, who was previously healthy, entered the emergency department presenting with fever and pharyngeal pain that had persisted for 5 days. Contrast-enhanced abdominal computed tomography revealed a 3-cm area of low density in segment 6 of the liver, consistent with an abscess. Chest computed tomography also revealed that multiple nodes in both lungs were enlarged, and septic emboli were suspected. The patient was hospitalized and antibiotic treatment was initiated. On hospital day 6, blood culture results confirmed Fusobacterium necrophorum septicemia. The patient was diagnosed with Lemierre’s syndrome, as pharyngitis developed into bacteremia associated with hepatic and pulmonary lesions. The patient’s condition improved with antibiotics and he was discharged following three weeks of treatment in the hospital.ConclusionWith the widespread use of antibiotics, Lemierre’s syndrome is rarely encountered anymore, but it can be fatal if not properly diagnosed. It is a crucial differential diagnosis in young patients exhibiting septicemia or multiple metastatic infection of unknown origin.

show abstract

“…Fusobacterium are usually found as part of the normal oral, gastrointestinal and genital flora, but may induce septic thrombophlebitis in the neighboring neck vessels when the infection is associated with an oropharyngeal abscess. The clinical spectrum may be wide, including abscess formation, bacteremia, puerperal infections, and septic shock[ 2 , 3 , 4 , 5 , 6 ]. Some reliable studies on Fusobacterium [ 7 , 8 ] revealed an overall incidence of bacteremia of 0.55 cases per 100,000 population per year, and a wide spectrum of clinical features.…”

Section: Introductionmentioning

confidence: 99%

Clinical Features and Outcomes of Fusobacterium Species Infections in a Ten-Year Follow-up

García-Carretero

Lopez-Lomba

Carrasco-Fernández

et al. 2017

The Journal of Critical Care Medicine

View full text Add to dashboard Cite

ObjectiveAlthough uncommon, Fusobacterium infections have a wide clinical spectrum, ranging from local pharyngeal infections to septic shock. Our aim was to characterize and analyze the clinical features and outcomes in patients with Fusobacterium infections, and determine which variables were able to predict a poor outcome.MethodsWe conducted a retrospective, hospital-based study using the computerized records of a second-level Spanish general hospital, serving a population of 155,000 inhabitants. The cohort was enrolled among patients cared for at the hospital between 2007 and 2016. Demographic, clinical data, microbiological characterization and outcomes at discharge, were analyzed.ResultsWe collected data for all 26 patients over a 10-year period (annual incidence of 1.78 per 100,000), with an incidence of bacteremia of 0.53 cases per 100,000 population per year. F. nucleatum and F. necrophorum were the most frequent isolations (53.8% and 38.5%, respectively). F. necrophorum was found to be associated with a younger population. Although we found no deaths attributable to Fusobacterium, 15 patients (57%) were found to have severe infections due to this pathogen, and 7 patients (26.9%) were admitted to the Intensive Care Unit (ICU). The only identifiable risk factor for a severe infection (sepsis, septic shock or ICU admission) was the presence of bacteremia.ConclusionsFusobacterium infections are uncommon. F. necrophorum tends to cause infection in younger individuals, while F. nucleatum has a preference for older patients. The clinical spectrum is wide, ranging from local, nonsevere infections, such as sinusitis or pharyngitis, to abscess formation and life-threatening infections.

show abstract

A Case of Lemierre's Syndrome in Association with Liver Abscess without Any Other Metastatic Lesions

Cited by 19 publications

References 23 publications

Lemierre’s syndrome: current perspectives on diagnosis and management

Lemierre’s syndrome: current perspectives on diagnosis and management

Liver abscessation and multiple septic pulmonary emboli associated with Lemierre’s syndrome: a case report

Clinical Features and Outcomes of Fusobacterium Species Infections in a Ten-Year Follow-up

Contact Info

Product

Resources

About

A Case of Lemierre's Syndrome in Association with Liver Abscess without Any Other Metastatic Lesions

Cited by 19 publications

References 23 publications

Lemierre&rsquo;s syndrome: current perspectives on diagnosis and management

Lemierre&rsquo;s syndrome: current perspectives on diagnosis and management

Liver abscessation and multiple septic pulmonary emboli associated with Lemierre’s syndrome: a case report

Clinical Features and Outcomes of Fusobacterium Species Infections in a Ten-Year Follow-up

Contact Info

Product

Resources

About

Lemierre’s syndrome: current perspectives on diagnosis and management

Lemierre’s syndrome: current perspectives on diagnosis and management