Complex Lemierre syndrome with multisystemic abscesses

Bourgeaud, Johan; Delabays, Benoît; Bogaart, Lorena Van den; Ratano, Damian

doi:10.1136/bcr-2023-254638

Cited by 3 publications

(4 citation statements)

References 37 publications

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“…Anticoagulation’s role in treating internal jugular vein thrombosis secondary to Lemierre’s syndrome remains controversial. Current practices vary, with there being no consensus on the optimal regimen or duration of therapy [ 40 , 41 , 42 ]. This area is ripe for research, with the potential for randomized controlled trials to provide much-needed evidence to guide clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…However, additional factors that may increase the likelihood of a child developing this syndrome have been identified [ 39 ]. Among these, a recent history of viral infection, such as infectious mononucleosis, has been shown to compromise the oropharyngeal mucosa, making it potentially susceptible to bacterial invasion [ 21 , 40 ]. Children who are immunocompromised due to conditions such as diabetes or HIV or due to immunosuppressive therapy for other medical conditions may also have a higher risk [ 41 , 42 , 43 ].…”

Section: Methodsmentioning

confidence: 99%

“…Children who are immunocompromised due to conditions such as diabetes or HIV or due to immunosuppressive therapy for other medical conditions may also have a higher risk [ 41 , 42 , 43 ]. Lesions of the oropharyngeal mucosa, which can result from an apparently benign event such as a throat swab or tonsillectomy [ 44 ], could predispose a child to develop Lemierre’s syndrome by providing a pathway for bacteria to invade the jugular vein [ 38 , 40 ]. Genetic predisposition may also play a role in some cases, although the specific genetic factors involved are still being studied [ 45 ].…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Pediatric Lemierre’s Syndrome: A Comprehensive Literature Review

Lavalle,

Masiello,

Cocuzza

et al. 2024

Pediatric Reports

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Background: Lemierre syndrome is a rare, potentially fatal complication of oropharyngeal infections characterized by septic thrombophlebitis of the internal jugular vein. It primarily affects healthy adolescents and young adults. Its incidence declined after the antibiotic era, but it may have resurged in recent decades, likely due to judicious antibiotic use and increasing bacterial resistance. Prompt diagnosis and treatment are imperative to prevent significant morbidity and mortality. Methods: Lemierre syndrome has been called “the forgotten disease,” with a reported incidence of around 3.6 cases per million. The mean age at presentation is around 20 years old, though it can occur at any age. Lemierre Syndrome follows an oropharyngeal infection, most commonly pharyngitis, leading to septic thrombophlebitis of the internal jugular vein. F. necrophorum is the classic pathogen, though other organisms are being increasingly isolated. Metastatic infections, especially pulmonary, are common complications. Contrast-enhanced CT of the neck confirming internal jugular vein thrombosis is the gold standard for diagnosis. Long-course broad-spectrum IV antibiotics covering anaerobes are the mainstays of the disease’s treatment. Anticoagulation may also be considered. Mortality rates are high without treatment, but most patients recover fully with appropriate therapy. Conclusions: Lemierre syndrome should be suspected in patients with prolonged pharyngitis followed by unilateral neck swelling and fevers. Early diagnosis and prompt antibiotic therapy are key, given the potential for disastrous outcomes if untreated. An increased awareness of Lemierre syndrome facilitates its timely management.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Pediatric Lemierre’s Syndrome: A Comprehensive Literature Review

Lavalle,

Masiello,

Cocuzza

et al. 2024

Pediatric Reports

View full text Add to dashboard Cite

show abstract

“…While isolation of an organism on culture media requires viable growth of the bacteria from the clinical specimen, rRNA PCR can detect non-viable bacterial DNA after the initiation of antibiotics from sterile sites [20]. This technique has become an important clinical tool for the detection and identification of bacterial pathogens in those patients with high clinical suspicion of infection but negative bacterial cultures and has been repeatedly proposed as an important technique especially in cases of suspected septic thrombophlebitis [21,22]. In a study conducted by Miller et al [23], the use of PCR with 16s rRNA testing on all heart valve tissues exhibited notable diagnostic performance in identifying infectious endocarditis (IE).…”

Section: Case Reports In Gastroenterologymentioning

confidence: 99%

Gastrointestinal Variant of Lemierre Syndrome due to Fusobacterium nucleatum: A Case Report

Salam,

Verma,

Noeske

et al. 2024

Case Rep Gastroenterol

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Introduction: Pyogenic liver abscess is a noteworthy health concern in North America, characterized by a mortality rate ranging from 2 to 12%. This condition is often polymicrobial, with Streptococcus species and Escherichia coli as the predominant causal pathogens in Western countries. Fusobacterium species, typically commensals of gastrointestinal, genital, and oral flora, have been implicated in the rare formation of tonsillar abscesses and Lemierre syndrome, including its gastrointestinal variant known as pylephlebitis. Case Presentation: We present the case of an immunocompetent male with a 2-week history of abdominal distention and pain. Abdominal magnetic resonance imaging revealed multiseptated cystic hepatic masses and portal vein thrombosis. A subsequent liver biopsy confirmed Fusobacterium nucleatum etiology. The patient was initiated on intravenous cefepime and oral metronidazole antibiotics. Unfortunately, the patient succumbed to cardiac arrest before a final diagnosis could be established. Conclusion: Fusobacterium species-associated liver abscess, coupled with the rare gastrointestinal variant of Lemierre syndrome (pylephlebitis), poses a significant mortality risk. This case underscores the rarity and clinical challenges associated with these conditions. Increased awareness among clinicians is crucial for early diagnosis and prompt intervention, potentially improving outcomes in such cases.

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Lemierre’s syndrome as a rare cause of septic pulmonary embolism (case report)

Chipigina,

Karpova,

Vinokurov

et al. 2024

Klinicist

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Objectives. The purpose of this work is to provide a clinical case study of Lemierre’s syndrome (LS) in order to raise awareness amongst doctors of various medical specialties regarding this rare cause of septic pulmonary embolism (SPE).Materials and methods. The patient in clinical case is a 25-year-old female who was hospitalized due to SPE, which had been complicated by respiratory distress, pneumothorax and septic shock. The initial source of embolus lung damage was the septic thrombosis of both the internal and external jugular veins. This thrombosis occurred against the backdrop of a carbuncle of the lower lip, an inflammatory infiltrate at the bottom of the mouth, an abscess in the soft tissue of the chin and neck cellulitis, which correspond to the diagnostic criteria for Lemierre Syndrome.Results. The literature data of the epidemiology, etiology, pathogenic mechanisms of the venous thrombosis, embolic and septic complications among patients with LS are presented. The article discusses the clinical features and course of the disease, as well as key aspects of diagnosis, including current diagnostic criteria, with regard to the typical and atypical variants of LS. The principles of antibiotic therapy and the possibility of anticoagulation therapy in cases of septic pulmonary emboli associated with head and neck vein thrombosis are also considered.Conclusion. LS is a rare, but clinically significant condition characterized by the development of septic thrombosis in the internal jugular vein in response to acute suppurative inflammation of the head and neck. In typical cases, the causative organism is Fusobacterium necrophorum, or other anaerobic bacteria. This pathological condition is often accompanied by multiple other septic complications, with the most significant being the development of septic pulmonary embolism. Clinical observation indicates the necessity for including LS in the differential diagnosis among causes of the septic pulmonary embolism, and for adopting a multidisciplinary approach in the treatment of these patients in a specialized multifield hospital. Identification and diagnosis of Lemierre Syndrome can be challenging due to its low incidence and variable clinical presentation. Although the condition is not widely recognized among physicians, an understanding of the basic principles of its diagnosis and management can significantly improve treatment outcomes and patients prognosis.

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Complex Lemierre syndrome with multisystemic abscesses

Cited by 3 publications

References 37 publications

Pediatric Lemierre’s Syndrome: A Comprehensive Literature Review

Pediatric Lemierre’s Syndrome: A Comprehensive Literature Review

Gastrointestinal Variant of Lemierre Syndrome due to <i>Fusobacterium nucleatum</i>: A Case Report

Lemierre’s syndrome as a rare cause of septic pulmonary embolism (case report)

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