Fusobacterium necrophorum Pharyngitis Complicated by Lemierre’s Syndrome

Abstract

We report the case of an 18-year-old woman who was referred to our outpatient clinic because of a 2-week history of sore throat, high fever, and neck tenderness unresponsive to a 7-day amoxicillin/clavulanic acid course. Infectious mononucleosis was initially suspected, but an extremely high value of procalcitonin and clinical deterioration suggested a bacterial sepsis, prompting the patient admission to our internal medicine ward. Blood cultures were positive for Fusobacterium necrophorum. CT scan detected a parapharyngeal abscess, a right internal jugular vein thrombosis, and multiple bilateral lung abscesses, suggesting the diagnosis of Lemierre's syndrome. The patient was treated with a 2-week course of metronidazole and meropenem with a gradual clinical recovery. She was thereafter discharged home with metronidazole and amoxicillin/clavulanic acid for 14 days and a 3-month course of enoxaparin, experiencing an uneventful recovery. The present case highlights the importance of taking into consideration the Lemierre's syndrome whenever a pharyngotonsillitis has a severe and unusual course.

Complete Genome Sequence of Fusobacterium necrophorum subsp. necrophorum ATCC 25286

“…In humans, Fusobacterium necrophorum can cause the rare and life-threatening Lemierre syndrome, which begins as bacterial pharyngitis and rapidly progresses to septic thrombophlebitis of the jugular vein (3). Lemierre syndrome most frequently manifests in patients age 15 to 30 and can lead to further complications, including pharyngeal and lung abscesses (4). F.…”

Identification and Management of Fusobacterium Nucleatum Liver Abscess and Bacteremia in a Young Healthy Man

“…A study by Leli et al showed that F. nucleatum bloodstream infections correlated to a median procalcitonin level of about 0.38 ng/mL [ 17 ]. One case report described a procalcitonin level elevated to 294 ng/mL in a patient with F. necrophorum pharyngotonsillitis, Lemierre’s syndrome, and bacteremia [ 18 ]. This case report describes a rare case of extreme procalcitonin elevation to over 200 ng/mL in the setting of F. nucleatum liver abscess and bacteremia.…”

Lemierre’s syndrome: Case report and brief literature review

“…We found that 9 out of 16 patients did see a healthcare provider (56%) with one of them having been previously hospitalized before being transferred to another facility. and 9 of those 10 patients received antibiotics (56%) [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] .…”

“… Author (year) Assessed as outpatient Outpatient antibiotics prescribed? Initial symptoms Tawa et al (2016) [3] Yes None odynophagia, left cervical pain, and fever Stefan et al (2016) [4] Yes Clarithromycin 1-week history of severe sore throat and fever Roland et al (2016) [5] Yes Amoxicillin/clavulanic acid dental infection present in the left inferior premolar for a month Chamseddin et al (2016) [6] Yes Amoxicillin severe odynophagia and sore throat Fielding et al (2016) [7] Yes Clarithromycin 7-day history of worsening dysphagia, non-productive cough, hoarseness, fever, rigors, general malaise and anorexia Panchavati et al (2017) [8] Yes Ampicillin/sulbactam and amoxicillin fever, rigors and sore throat 7 days Faraone et al (2016) [9] Yes Amoxicillin/clavulanic acid 2-week history of sore throat, high fever, and mild neck tenderness Kumral et al (2017) [10] No None 7 day history of fever (Tmax 40.4C), left sided throat pain, fatigue, and myalgias Budhram et al (2017) [11] No None 1 week of right sided partial ophthalmoplegia and ptosis 4 month history of headache Farhan et al (2016) [12] ...…”