From a sore throat to the intensive care unit: the Lemierre syndrome

Abstract

Lemierre syndrome is characterized by an acute oropharyngeal infection, suppurative thrombophlebitis of the internal jugular vein and metastatic infections. The infection is usually caused by Fusobacterium necrophorum. We report on a 19-year-old male patient who was admitted with a five-day history of fever, sore throat and progressive dyspnea. Computed tomography of the neck and chest revealed a parapharyngeal abscess, jugular vein thrombosis, descending necrotizing mediastinitis and multiple areas of bilateral consolidation and cavitations within the lungs. Fusobacterium necrophorum was identified in the blood culture. Early combined abscess drainage with neck and chest incisions, together with broad spectrum intravenous antibiotic treatment and medical management in an intensive care unit resulted in a good clinical outcome.

Pediatric Lemierre’s Syndrome: A Comprehensive Literature Review

“…The current reliance on clinical presentation and imaging may not be sufficient, particularly in atypical presentations or in resource-limited settings. The phenomenon of antibiotic resistance is of particular concern in the management of Lemierre’s syndrome [ 36 , 37 ]. With F. necrophorum and other potential anaerobic pathogens showing increased resistance to common antibiotics, research into these patterns is essential for informing empirical therapy [ 5 , 9 , 34 , 38 ].…”

“…Managing these infections often requires prolonged courses of targeted intravenous antibiotic therapy, which can extend hospital stays and increase the risk of hospital-acquired infections [ 35 , 36 ]. The need for intensive care unit (ICU) admission is indicative of the severity of this syndrome, with reports suggesting that up to two-thirds of pediatric patients with Lemierre’s syndrome require ICU care [ 37 ]. Timely and effective treatment has been instrumental in reducing the mortality rate of Lemierre’s syndrome to 6% or below [ 3 ].…”

Lemierre Syndrome and Nosocomial Transmission of Fusobacterium Necrophorum From Patient to Physician

“…The role of surgery for abscess drainage and thrombectcomy in this entity is similarly controversial. However, most cases resolve without surgical intervention [7] .…”

Answer to Case of the Month #151

“…Associated with those steps are a number of common clinical manifestations secondary to septic embolization or hematogenous bacterial spread including pneumonia, endocarditis, and arthritis [15]. Among those symptoms less commonly reported are cavitating pneumonia, gastrointestinal complaints (such as abdominal pain, nausea, and vomiting), hepatitis, and jaundice [13,15–17].…”