Lemierre's Syndrome Associated with Periodontal Injury-derived Odontogenic Infection that Did Not Respond to Meropenem

Abstract

A 33-year-old previously healthy man injured his gums and subsequently developed dyspnea and fever. A chest X-ray showed nodules and infiltrates in both lungs, and the patient was initially diagnosed with pneumonia and administered meropenem hydrate, although his symptoms did not improve. A blood culture identified Fusobacterium necrophorum, and thrombophlebitis in the internal jugular vein of the neck was observed on computed tomography and ultrasound scans. We replaced the meropenem with clindamycin, sulbactam/ ampicillin and metronidazole, and the patient's symptoms improved.

Lemierre’s syndrome: current perspectives on diagnosis and management

“… 4 Patients are often young (age 16–30 years) and otherwise healthy, but appear acutely ill with tachycardia, tachypnea, hypotension, and a poor saturation (often <95%). 2 , 3 , 5 , 6 Laboratory findings showed leukocytosis with dominating neutrocytosis and elevated C-reactive protein as well as signs of organ failure, such as elevated liver enzymes. Imaging of the internal jugular vein showed thrombosis.…”

“… 7 Other less severe complications include metastatic infections in joints, internal organs (often lungs), and/or the brain. 6 …”

“…This review yielded at total number of 137 cases 2 , 3 , 5 , 6 , 8 , 10 – 90 including both case reports and minor reviews. The major clinical characteristics of LS are reported in Table 1 .…”

Thoracic pain associated with an odontogenic infection: An unusual Lemierre's syndrome

“…It is characterized by thrombophlebitis of the internal jugular vein, secondary to an anaerobic infection in the head/neck region, complicated by sepsis and the septic embolization of the organs at a distance, especially the lungs. Other organs that may be involved include the liver, spleen, joints, heart, and brain . The most frequently observed primary infections are pharyngitis and tonsillitis, involving 85% of cases .…”

“…Other organs that may be involved include the liver, spleen, joints, heart, and brain. [2][3][4] The most frequently observed primary infections are pharyngitis and tonsillitis, involving 85% of cases. 5 Mastoiditis and odontogenic infections are less common, corresponding to 3% and 2% of cases, respectively.…”