Pyomyositis with Iliac Vein Thrombophlebitis and Septic Pulmonary Embolism: A Unique Case of Reverse Lemierre Syndrome

Abstract

Background:The reverse Lemierre's syndrome refers to a septic thrombosis in noncervical sites. Case Report: A 40 years old diabetic patient presented with fever and acute onset pain in left gluteal region radiating to left thigh. Magnetic resonance imaging (MRI) showed pyomyositis and internal iliac vein thrombosis. Computed tomography (CT) venography showed non-enhancing filling defects within common iliac propagating into internal iliac veins along with intramuscular abscesses while whole body positron emission tomography (PET-CT) revealed bilateral scattered pulmonary nodules suggestive of septic emboli. The patient responded to broad spectrum antibiotics. Conclusion: This unique case of reverse Lemierre syndrome highlights the importance of multimodality imaging including PET-CT in identifying additional foci infection in lungs.