Liver abscessation and multiple septic pulmonary emboli associated with Lemierre’s syndrome: a case report

Abstract

BackgroundIn Lemierre’s syndrome, patients first exhibit pharyngitis and peritonsillar abscessation, followed by the development of anaerobic bacterial (usually Fusobacterium necrophorum) septicemia and metastatic infections throughout the body. However, these infections rarely affect the liver. We describe a case of Lemierre’s syndrome, in which the first disease manifestation was liver abscess, for drawing attention of emergency physicians to this rare but fatal disease.Case presentationA 28-year-old Asian ethnicity Filipino male, who was previously healthy, entered the emergency department presenting with fever and pharyngeal pain that had persisted for 5 days. Contrast-enhanced abdominal computed tomography revealed a 3-cm area of low density in segment 6 of the liver, consistent with an abscess. Chest computed tomography also revealed that multiple nodes in both lungs were enlarged, and septic emboli were suspected. The patient was hospitalized and antibiotic treatment was initiated. On hospital day 6, blood culture results confirmed Fusobacterium necrophorum septicemia. The patient was diagnosed with Lemierre’s syndrome, as pharyngitis developed into bacteremia associated with hepatic and pulmonary lesions. The patient’s condition improved with antibiotics and he was discharged following three weeks of treatment in the hospital.ConclusionWith the widespread use of antibiotics, Lemierre’s syndrome is rarely encountered anymore, but it can be fatal if not properly diagnosed. It is a crucial differential diagnosis in young patients exhibiting septicemia or multiple metastatic infection of unknown origin.

Lemierre’s syndrome: current perspectives on diagnosis and management

“…A larger proportion of cases (71 cases) had septic emboli in the lungs, but septic emboli were also seen in other organs, such as the liver, 12 , 38 , 87 spleen, 81 joints, 38 , 70 heart, 38 and the central nervous system, 29 , 31 even though in smaller numbers.…”

Scoping review on diagnostic criteria and investigative approach in sepsis of unknown origin in critically ill patients

“…Point of care ultrasound was demonstrated to be useful to assess many body compartments including pulmonary, urinary, biliary and musculoskeletal [ 55 – 57 ]. Computed tomography (CT) was often reported as a helpful screening tool to increase diagnostic yield when source of sepsis is unknown [ 26 , 31 , 39 , 49 , 51 , 57 – 63 ]. Along with plain radiographs, ultrasound and echocardiography, studies have generally recommended that it is essential to perform a screening CT scan before a diagnosis of SUO is made [ 25 , 28 – 30 , 32 , 33 ].…”

“…QuantiFERON-TB Gold to screen for mycobacterium tuberculosis was mentioned in one study [ 74 ]. Five studies mentioned the need for human immunodeficiency virus testing [ 25 , 37 , 39 , 42 , 53 ]. Procalcitonin was tested in 10/89 (11%) studies as a marker suggestive of bacterial sepsis, although it cannot help to localize the site of infection [ 18 , 30 , 34 , 38 , 41 , 52 , 62 , 65 , 66 , 75 ].…”

“…Despite the universal absence of history as a component of the diagnostic criteria for SUO (when provided), 30/89 (34%) of studies discussed the merits of specific, focused history taking. Most of these studies describe how a particular aspect of history helped direct further investigations to confirm the infective source or to suggest alternative diagnoses [34][35][36][37][38][39][40]. Important aspects of history taking included travel history which may reveal exposure to endemic pathogens, such as malaria and rickettsia [34,37].…”

A Case of Lemierre\'s Syndrome in Intensive Care Unit

“…[ 2 ] In a systematic review by Johannesen and Bodtger, other pathogens causing Lemierre's syndrome include Streptococcus , Staphylococcus aureus , Klebsiella spp., and Pseudomonas . [ 3 ] Septic emboli in the liver and lung were commonly identified,[ 4 ] but rarer complications including necrotizing fasciitis, mycotic aneurysms, and central nervous system infections have also been reported. [ 3 5 6 ] Lemierre's syndrome, often known as “the forgotten disease,” has a markedly reduced incidence since the 1940s, probably due to the widespread use of antimicrobials.…”