Neurological Variant of Lemierre's Syndrome with Purulent Meningitis: A Case Report and Literature Review

Bouziri, Asma; Douira, W.; Khaldi, Abdelhamid; Mrad, Sonia Mazigh; Bouyahia, Olfa; Smaoui, Hanène; Sammoud, A.; Menif, Khaled; Jaballah, Nejla Ben

doi:10.3109/15513815.2011.618868

Cited by 6 publications

(4 citation statements)

References 15 publications

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“…This syndrome was first diagnosed by Lemierre 26 in 1936 as a local suppuration that evolved with thrombophlebitis and then with multiple septic abscess, mainly in the lung, with Fusobacterium necrophorum being the most common involved bacteria. 27 The neurological involvement of our case could be due to septic embolization from the infected jugular thrombophlebitis characterizing an atypical LS, 28 but the spreading of the sinus infection to the central nervous system by contiguity with bone perforation seems to be more reasonable. However, the mastoid involvement may also be explained by septic embolization.…”

Section: Discussionmentioning

confidence: 75%

Bacterial sinusitis and its frightening complications: subdural empyema and Lemierre syndrome

Benevides¹,

Salgado²,

Ferreira³

et al. 2015

ACR

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The symptoms of a previously healthy 14-year-old female with an initial history of tooth pain and swelling of the left maxillary evolved to a progressive headache and altered neurological findings characterized by auditory hallucinations, sleep disturbances, and aggressiveness. She was brought to the emergency department after 21 days of the initial symptoms. An initial computed tomography (CT) scan showed frontal subdural empyema with bone erosion. The symptoms continued to evolve to brain herniation 24 hours after admission. A second CT scan showed a left internal jugular vein thrombosis. The outcome was unfavorable and the patient died on the second day after admission. The autopsy findings depicted rarefaction of the cranial bone at the left side of the frontal sinus, and overt meningitis. The severe infection was further complicated by thrombophlebitis of the left internal jugular vein up to the superior vena cava with septic embolization to the lungs, pneumonia, and sepsis. This case report highlights the degree of severity that a trivial infection can reach. The unusual presentation of the sinusitis may have wrongly guided the approach of this unfortunate case.

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Section: Discussionmentioning

confidence: 75%

Bacterial sinusitis and its frightening complications: subdural empyema and Lemierre syndrome

Benevides¹,

Salgado²,

Ferreira³

et al. 2015

ACR

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“…This was true both for absolute numbers and for the ratio of Lemierrerelated papers to the total number of articles on the PubMed repository in the same period. Several factors may have contributed to this increase, including the publication of epidemiological studies [3], narrative reviews and case reports in major journals [40,41]; an increasing interest for the concept of 'inflammatory thrombosis'; and publication bias, leading to more 'unusual' cases of Lemierre syndrome (not due to oropharyngeal infection by Fusobacterium necrophorum, or less often associated with septic embolism) being reported in recent years [42][43][44]. As indirect as this evidence can be, the apparent increase in the number of reports and patients is consistent with a recently published retrospective multicentric population-based study reporting that invasive infections caused by Fusobacterium necrophorum increased in Sweden from 2010 to 2017 [45].…”

Section: Discussionmentioning

confidence: 99%

Patients with Lemierre syndrome have a high risk of new thromboembolic complications, clinical sequelae and death: an analysis of 712 cases

et al. 2020

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Background. Lemierre syndrome is characterized by head/neck vein thrombosis and septic embolism usually complicating an acute oropharyngeal bacterial infection in adolescents and young adults. We described the course of Lemierre syndrome in the contemporary era. Methods. In our individual-level analysis of 712 patients (2000-2017), we included cases described as Lemierre syndrome if these criteria were met: (i) primary site of bacterial infection in the head/neck; (ii) objectively confirmed local thrombotic complications or septic embolism. The study outcomes were new or recurrent venous thromboembolism or peripheral septic lesions, major bleeding, all-cause death and clinical sequelae. Results. The median age was 21 (Q1-Q3: 17-33) years, and 295 (41%) were female. At diagnosis, acute thrombosis of head/neck veins was detected in 597 (84%) patients, septic embolism in 582 (82%) and both in 468 (80%). After diagnosis and during inhospital follow-up, new venous thromboembolism occurred in 34 (5.2%, 95% CI 3.8-7.2%) patients, new peripheral septic lesions became evident in 76 (11.7%; 9.4-14.3%). The rate of either was lower in patients who received anticoagulation (OR: 0.59; 0.36-0.94), higher in those with initial intracranial involvement (OR: 2.35; 1.45-3.80). Major bleeding occurred in 19 patients (2.9%; 1.9-4.5%), and 26

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“…Treatment regimens center around the administration of intravenous antibiotics, with the inclusion of anticoagulation therapy in some cases. However, despite the availability of potent antibiotics, mortality rates can reach up to 18%, with significant morbidity stemming from potential metastatic infections [ 3 , 33 , 34 ]. The need for a multi-week course of antibiotics and, in some cases, intensive care admission further underscores the severity of the condition [ 32 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…Metastatic infections are a prominent source of morbidity in Lemierre’s syndrome due to septic emboli, or infected blood clots, dislodging from the site of the original infection and spreading through the bloodstream to distant organs [ 26 ]. Several secondary infections can develop, such as pneumonia [ 5 , 31 ], septic arthritis, osteomyelitis, or even meningitis [ 33 , 34 ]. Managing these infections often requires prolonged courses of targeted intravenous antibiotic therapy, which can extend hospital stays and increase the risk of hospital-acquired infections [ 35 , 36 ].…”

Section: Methodsmentioning

confidence: 99%

Pediatric Lemierre’s Syndrome: A Comprehensive Literature Review

Lavalle,

Masiello,

Cocuzza

et al. 2024

Pediatric Reports

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Background: Lemierre syndrome is a rare, potentially fatal complication of oropharyngeal infections characterized by septic thrombophlebitis of the internal jugular vein. It primarily affects healthy adolescents and young adults. Its incidence declined after the antibiotic era, but it may have resurged in recent decades, likely due to judicious antibiotic use and increasing bacterial resistance. Prompt diagnosis and treatment are imperative to prevent significant morbidity and mortality. Methods: Lemierre syndrome has been called “the forgotten disease,” with a reported incidence of around 3.6 cases per million. The mean age at presentation is around 20 years old, though it can occur at any age. Lemierre Syndrome follows an oropharyngeal infection, most commonly pharyngitis, leading to septic thrombophlebitis of the internal jugular vein. F. necrophorum is the classic pathogen, though other organisms are being increasingly isolated. Metastatic infections, especially pulmonary, are common complications. Contrast-enhanced CT of the neck confirming internal jugular vein thrombosis is the gold standard for diagnosis. Long-course broad-spectrum IV antibiotics covering anaerobes are the mainstays of the disease’s treatment. Anticoagulation may also be considered. Mortality rates are high without treatment, but most patients recover fully with appropriate therapy. Conclusions: Lemierre syndrome should be suspected in patients with prolonged pharyngitis followed by unilateral neck swelling and fevers. Early diagnosis and prompt antibiotic therapy are key, given the potential for disastrous outcomes if untreated. An increased awareness of Lemierre syndrome facilitates its timely management.

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Neurological Variant of Lemierre's Syndrome with Purulent Meningitis: A Case Report and Literature Review

Cited by 6 publications

References 15 publications

Bacterial sinusitis and its frightening complications: subdural empyema and Lemierre syndrome

Bacterial sinusitis and its frightening complications: subdural empyema and Lemierre syndrome

Patients with Lemierre syndrome have a high risk of new thromboembolic complications, clinical sequelae and death: an analysis of 712 cases

Pediatric Lemierre’s Syndrome: A Comprehensive Literature Review

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