Lemierre syndrome complicated by bronchopleural fistula

Abstract

We present a 19-year-old woman, a case of Lemierre syndrome, who presented with fever, sore throat, and left shoulder pain. Imaging revealed a thrombus in the right internal jugular vein, multiple nodular shadows below both pleura with some cavitations, right lung necrotizing pneumonia, pyothorax, abscess in the infraspinatus muscle, and multiloculated fluid collections in the left hip joint. After inserting a chest tube and administering urokinase for the pyothorax, a bronchopleural fistula was suspected. The fistula was identified based on clinical symptoms and computed tomography scan findings. If a bronchopleural fistula is present, thoracic lavage should not be performed as it may cause complications such as contralateral pneumonia due to reflux.

An inappropriate therapeutic intervention can delay completion of treatment: Caution required!

“…In this issue of the journal, the study by Kodaka et al . [ 7 ] should be commended for reporting a complication of Lemierre syndrome, not previously reported in the literature, because this adds to the literature on treatment of this serious disease and its complications. Furthermore, Kodaka et al .…”

“…Furthermore, Kodaka et al . [ 7 ] offer an opportunity to revisit the treatment approach to a potentially serious complication of BPF. [ 8 ]…”

“…Without detracting from the case reported by Kodaka et al . [ 7 ] and accepting its validity, uncertainty remains about the origin of the fistula that is difficult to clarify based solely on the evidence presented by the authors. Can the causes be traced to a spontaneous pneumothorax and therefore the formation of fistula or to a pulmonary rupture and consequent fistula following iatrogenic application of a chest drain in a non-compromised or compromised lung area?…”