Lemierre’s syndrome: a rare cause of sepsis presenting with an absence of throat symptoms

Abstract

A 16-year-old boy presented to hospital with a 6-day history of diarrhoea, vomiting and abdominal pain. During his admission he was found to be hypotensive, tachycardic and persistently feverish. Blood cultures taken on admission isolated CT scanning of his neck showed a non-occlusive thrombus of the right internal jugular vein and a small right parapharyngeal abscess. CT scans of the chest and abdomen revealed multiple pulmonary abscesses, bilateral pleural effusions and splenomegaly. Treatment consisted of an unfractionated heparin infusion and intravenous antibiotics. A right-sided intercostal drain was inserted for a complex right-sided empyema. He subsequently developed a left-sided pleural effusion which was treated with a video-assisted thoracoscopic surgery (VATS) pleurodesis procedure. His fever resolved after his VATS pleurodesis procedure 3 weeks after initial presentation. Clinically he made a slow recovery but now is improved after 6 weeks of intravenous antibiotics and was discharged home.

Case report: Metagenomics next-generation sequencing in the diagnosis of septic shock due to Fusobacterium necrophorum in a 6-year-old child

“…Metronidazole is recommended in combination with b-lactam antibiotics (Sacco et al, 2019;Tay and Vasoo, 2022). In current research, the average duration of antibiotic use was as long as 2-4 weeks, and some severe patients were treated for 8-16 weeks (Sheehan et al, 2019;Gama et al, 2020;Tamura et al, 2020;El Chebib et al, 2020;Repper et al, 2020;Monroe and Amlie-Lefond, 2018;Dal Bo et al, 2019;Whittle et al, 2018;Rana et al, 2017;Sinatra and Alander, 2017;He et al, 2015;Creemers-Schild et al, 2014). In this case, to cover the anaerobic bacteria as well as some pathogenic or coinfected G-bacilli and streptococci, the broad-spectrum carbapenem antibiotics were initially used empirically.…”

“…collected and analyzed, including baseline data, clinical symptoms, means of detection, complications, treatment, and outcome. The characteristics of reported cases are shown in Table 1 (Sheehan et al, 2019;Gama et al, 2020;Tamura et al, 2020;El Chebib et al, 2020;Repper et al, 2020;Monroe and Amlie-Lefond, 2018;Dal Bo et al, 2019;Whittle et al, 2018;Rana et al, 2017;Sinatra and Alander, 2017;He et al, 2015;Creemers-Schild et al, 2014).…”

Lemierre's syndrome: One rare disease-Two case studies

“…For both cases, patients experienced septic thrombophlebitis, and no parenteral anticoagulation was initiated, as the medical team felt that management of infection was adequate. Penicillin is a potential option if susceptibility shows sensitivity to it . Metronidazole, along with a beta‐lactam antibiotic for a total of 6 weeks is the recommended regimen for the management of Lemierre's syndrome.…”

“…Penicillin is a potential option if susceptibility shows sensitivity to it. [5][6][7][8][9] Metronidazole, along with a beta-lactam antibiotic for a total of 6 weeks is the recommended regimen for the management of Lemierre's syndrome. The 25-year-old female received 6 weeks of a beta-lactam antibiotic and 4 weeks of metronidazole, while the 28year-old male received 4 weeks of a beta-lactam antibiotic and 2 weeks of metronidazole.…”