Cardiac Tamponade in a Postpartum Woman with Lemierre's Syndrome

Abstract

A 23-year-old primigravida with Lemierre's syndrome developed pericardial tamponade secondary to mediastinal infection and anticoagulant therapy. Intrathoracic echocardiographic diagnosis during a period of cardiac arrest led to urgent pericardiocentesis and successful resuscitation.

Lemierre Syndrome

“…11 Other laboratory findings consistent with sepsis and metastatic organ involvement may be found. Aside from the common metastatic infections of the lungs and bone, septic arthritis, 17 disseminated intravascular coagulopathy, 11 meningitis, carotid thrombosis, 18 mediastinal infection with pericardial tamponade, 19 and liver abscesses may occur.…”

Lemierre's Syndrome Complicating Pregnancy

“…McLean and Tyler [1] reported a nearly fatal case in a 23-year-old primigravida that resulted in premature delivery of an infant that suffered significant neurological deficits at 26 weeks. In that case, LS was complicated by cardiopulmonary collapse due to mediastinitis, pericardial effusion and tamponade that required mechanical ventilation, cardioversion, and emergent pericardiocentesis.…”

“…The disease most commonly affects teenagers and young adults; therefore, it can occur in association with pregnancy. However, a PubMed, Ovid and Embase search from 1950 to March 2007, using search terms “Lemierre's syndrome and Lemierre's disease, pregnancy, gestation and cyesis,” revealed only one case in which the pregnancy was complicated by premature delivery of an infant that suffered significant neurological deficits at 26 weeks [1]. We present an atypical case diagnosed by chance in a previously healthy, young woman who developed the syndrome in the second trimester of pregnancy.…”

Lemierre Syndrome

“…6 Rarely, this syndrome is associated with headache, 4 carotid thrombosis, 5 and mediastinitis secondary to extension along the carotid sheath. 7 Lemierre syndrome is diagnosed by the finding of a characteristic oropharyngeal infection, bacteremia confirmed by at least 1 positive blood culture, clinical or radiographic evidence of internal jugular thrombophlebitis, and demonstrated septic emboli. 6 The characteristic pathogen is F. necrophorum, an oropharyngeal anaerobe.…”