Lemierre's syndrome, reemergence of a forgotten disease: a case report

Kushawaha, Anurag; Popalzai, Muhammed; El‐Charabaty, Elie; Mobarakai, Neville

doi:10.1186/1757-1626-2-6397

Cited by 23 publications

(18 citation statements)

References 14 publications

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“…Inside the abscess, anaerobic bacteria can flourish. When this abscess ruptures, the bacteria can infect nearby structures including the internal jugular vein [10][11][12]. In most cases, this process is interrupted early in the course with the prescription of penicillin for strep throat.…”

Section: Discussionmentioning

confidence: 99%

Lemierre’s Syndrome: The Result of an Incorrect Penicillin Allergy

Christopher¹,

Alyson²,

Katherine³

2017

Int Med Care

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We present a case of a previously healthy 21 year old male who presents with Lemierre's syndrome after getting inadequate treatment of a throat infection because of a penicillin allergy label. Lemierre's syndrome is a rare complication following an acute oropharyngeal infection due to the common use of penicillin in modern medicine. Unfortunately, many patients are labeled with a penicillin allergy at a young age and are therefore more susceptible to complications of not receiving the most effective treatment for, what should be, a routine illness.Correspondence to: Christopher DeZorzi, Internal Medicine PGY-1, 1759 Louis Place, Iowa City, IA 52245, USA; E-mail: christopher-dezorzi@uiowa.edu Case presentationA 21 y.o. male with no significant past medical history presents to the Emergency Room with shortness of breath and fever. Five days prior to presentation, he noted sore throat, fevers, and heartburn. Since that time, he has also noted increasing shortness of breath. He presented to an acute care clinic three days prior to presentation and had a positive rapid strep screen. He was given a script for azithromycin, due to a history of penicillin allergy, and magic mouthwash. He took Ibuprofen alternating with acetaminophen for fever, but continued having worsening dyspnea and a cough productive of clear sputum. He had significant pain over the right chest, 10/10 in severity, sharp in quality, exacerbated by deep breathing.In the ER his vital signs were significant for fever to 40.1 C, tachycardia, tachypnea, and hypoxia requiring 3L oxygen. Physical exam revealed significant diaphoresis and decreased breath sounds at the right base. He had dullness to percussion over the right lower lung field, but no egophany was noted. A chest X-Ray showed possible right pleural effusion with no consolidation (Figure 1). CTA was obtained and showed no pulmonary emboli but found right air space concerning for pneumonia and an abscess superior to his right lower lobe bronchus. Blood cultures were obtained, he was given fluids and started on Ceftriaxone and Azithromycin (Figure 2).On admission, Clindamycin was started for the concern of a pulmonary abscess until gram stains on the blood cultures grew Gram Negative and Gram Positive Rods. The patient was then converted to Ceftazidime, to cover possible pseudomonas, and Vancomycin, for possible MRSA. Over the next day, he continued to have significant right sided chest pain and persistent leukocytosis, fevers, and oxygen requirement. A repeat CXR was obtained on his third day of admission which showed a large right sided pleural effusion ( Figure 3). Blood cultures at this time came back positive for Fusobacterium necrophorum which raised immediate concern for Lemierre's syndrome. He was restarted on IV Clindamycin and a CT larynx and chest was obtained, showing a possible non-loculated empyema, worsening infectious pneumonia, a clot in the left internal jugular vein, but no retropharyngeal abscess (Figures 4 and 5). The Cardiothoracic surgery team was consulted and the...

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Section: Discussionmentioning

confidence: 99%

Lemierre’s Syndrome: The Result of an Incorrect Penicillin Allergy

Christopher¹,

Alyson²,

Katherine³

2017

Int Med Care

View full text Add to dashboard Cite

show abstract

“…Lemierre's syndrome was initially thought to be a rare disease, however many articles suggest an increasing occurrence (possibly due to antibacterial resistance) [2][3][4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…Fusobacterium necrophorum is the most virulent strain and most common pathogen isolated in Lemierre's syndrome [1,2,4]. It is an anaerobic, nonmotile, gram negative bacillus ( Figure 7).…”

Section: Discussionmentioning

confidence: 99%

“…Due to these toxins, Fusobacterium is able to affect previously healthy individuals. Some suggest that Fusobacterium also causes aggregation of platelets, further increasing its virulence [1,2,4]. According to one article, the release of serotonin from platelets accompanied aggregation when fusobacterium was added to a platelet solution.…”

Section: Discussionmentioning

confidence: 99%

“…Within the posterior compartment is the carotid sheath enclosing the carotid artery and internal jugular vein (along with the vagus nerve). When the posterior compartment is infected, it can extend to cause thrombophlebitis of the jugular vein directly or can result from extension of peritonsillar vein thrombophlebitis [4].…”

Section: Discussionmentioning

confidence: 99%

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