Gastrointestinal variant of Lemierre's syndrome complicating ruptured appendicitis

Abstract

Fusobacterium necrophorum is a non-spore-forming, obligate anaerobic, filamentous, gramnegative bacillus that frequently colonizes the human oral cavity, respiratory tract, and gastrointestinal tract. Fusobacterium species have rarely been implicated in cases of gastrointestinal variant of Lemierre's syndrome. We describe a case of F. necrophorum bacteremia associated with suppurative porto-mesenteric vein thrombosis (PVT) following acute ruptured appendicitis. In addition, we list the documented twelve cases of Fusobacterium pylephlebitis. Recanalization of the porto-mesenteric veins and relief of the extrahepatic portal hypertension were achieved with early empiric antibiotic and local thrombolytic therapy. Our patient's case underscores the importance of recognizing Fusobacterium bacteremia as a possible cause of suppurative PVT after disruption of the gastrointestinal mucosa following an acute intraabdominal infectious process. Early treatment of this condition using anticoagulation and endovascular thrombolysis as adjunctive therapies may prevent PVT complications.

Abdominal variant of Lemierre’s Syndrome in a Patient with Pancreatic Adenocarcinoma

“…In this case, beta lactam/beta-lactamase inhibitors treated the patient successfully. Anticoagulant therapy in these patients is still under investigation [2][3][4] .…”

“…Moreover, surgical procedures in areas drained by portal system can also increase the risk of infection, as presented in our case 5 . Pylephlebitis can become complicated and result in hepatic abscesses - abdominal Lemierre’s syndrome, bowel ischemia, and portal hypertension 3 . It can also lead to sepsis, which is usually the most common cause of mortality in these patients 6 .…”

“…Computed tomography (CT) and ultrasonography are preferred imaging modalities. Contrast-enhanced CT is sensitive to visualize the thrombus in the portal system and the secondary hepatic abscesses 3 , 5 . In our case, we used MR imaging with diffusion-weighted sequence to help us accurately differentiate liver abscesses from liver metastases, since our patient was diagnosed with a pancreatic malignancy.…”

“…Rarely, these bacterial species can be the causative agent for pylephlebitis, which is defined as the development of thrombosis and inflammation of the portal vein that can lead to hepatic abscesses. This clinical picture is titled as “abdominal variant” of Lemierre’s syndrome that can be due to Fusobacterium necrophorum or Fusobacterium nucleatum, which is also part of the flora residing in the gut 3 .…”

Fusobacterium necrophorum subsp. necrophorum Liver Abscess with Pylephlebitis: An Abdominal Variant of Lemierre’s Syndrome

“…We searched the PubMed database for articles published in English using the following key words alone or in combination: pylephlebitis, suppurative portal vein thrombosis, Fusobacterium necrophorum, necrobacillosis, septic portal vein thrombosis, and infected portal vein thrombosis. Our search yielded 6 cases [7][8][9][10][11][12] (Table 2). e median age of patients was 37 years (ranging from 19 to 53 years) with 5:1 male to female ratio.…”