Lemierre's syndrome caused by Streptococcus pyogenes in an elderly woman

Abstract

Lemierre's syndrome is characterized by septic thrombophlebitis of the internal jugular vein. It typically presents in healthy adolescents or young adults, usually preceded by an oropharyngeal infection, with the most common offending pathogen being Fusobacterium necrophorum. We present a case of Lemierre's syndrome in an elderly woman without antecedent oropharyngeal infection, caused by Streptococcus pyogenes. She was successfully treated with combined surgical and medical management.

Anticoagulation Strategies in the Management of Lemierre Syndrome: A Systematic Review of the Literature

“…Significant neck pain, with or without other constitutional symptoms, was described in every patient with an IJV thrombosis. 16-25,27,28 This lends credence to the notion that LS should be readily included in the differential diagnosis of pharyngitis, tonsillitis, and other infections of the oral cavity. 11 An additional evaluation of the clinical presentation of the patients included in this evaluation revealed the presence of pulmonary implications, specifically rales, wheezing, and dyspnea.…”

“…Following discharge, the patient was prescribed edoxaban for 6 months in an effort to prevent the formation of additional thrombi, which was successfully accomplished. 22 A similar strategy was used by Siddique et al, 28 who also initiated heparin but later transitioned to rivaroxaban on discharge, for a total of 6 months. Of note, both the patients described by Kubota et al and Siddique et al had a thrombus of the IJV, thereby highlighting the safety and efficacy of DOACs for this specific anatomical location.…”

“…It is important to note that every case report initially began anticoagulation with an intravenous or subcutaneous medication, such as heparin, enoxaparin, or fondaparinux, though only 2 reports detailed a transition to a direct-acting oral anticoagulant (DOAC) as opposed to an outpatient regimen of enoxaparin or warfarin therapy. [16][17][18][19][20][21][22][23][24][25][26][27][28][29] Although difficult to ascertain definitive treatment regimens from the limited data available, several important distinctions can be gleaned with regard to patient presentation and the duration of anticoagulation therapy. Significant neck pain, with or without other constitutional symptoms, was described in every patient with an IJV thrombosis.…”

Lemierre’s disease: a typical presentation in two diabetic patients

“…In recent times many cases have been reported in the middle age and elderly individuals with pre-existing immunocompromised conditions such as diabetes mellitus, cancer etc. 5,6 The lung is considered to be the most common site of septic emboli followed by other organs such as liver, spleen, joints, heart and central nervous system. [10][11][12][13][14][15][16][17] Involvement of clivus and cranial nerves in LD is infrequent.…”

“…1,3 In recent times many cases of LD have been reported in the middle aged and elderly group of patients. [4][5][6] The possible causes include increase in comorbidities such as diabetes, use of immunosuppressive drugs and prevalence of drug resistance bacteria. 7 In this article, we present two such interesting cases of LD in diabetic patients with atypical presentations with a review of the literature.…”