Septic Pulmonary Emboli Complicating Mastoiditis: Lemierre's Syndrome Revisited

Abstract

Deep neck-space infections may cause potentially life-threatening complications of head and neck infections. Lateral pharyngeal space infections in particular predispose to development of suppurative jugular vein thrombosis, which may be associated with anaerobic bacteremia and septic pulmonary emboli (Lemierre's syndrome). We describe a case of Lemierre's syndrome, a very rare entity in the antibiotic era, complicating mastoiditis. Surgical debridement and drainage in conjunction with antibiotic therapy resulted in prompt improvement in the patient's condition.

Lemierre's syndrome presented with acute pancreatitis

“…To date, there are no published data reporting the relationship between acute pancreatitis and LS. As other reports suggested that septic emboli could metastasize to any part of the body through the blood stream,2, 3, 7, 8 there was a possibility that the patient's acute pancreatitis was caused by the metastatic septic emboli as a part of LS. The learning points from this case are that LS and acute pancreatitis can occur simultaneously and, most importantly, assuming one diagnosis without paying attention to the symptoms not compatible with it (in our case, oropharyngeal symptoms not compatible with acute pancreatitis) can lead to the delayed diagnosis of LS.…”

“…Pathogenesis is associated with pharyngitis affecting the palatine tonsils or peritonsillar tissue 7. Other sources include upper and lower respiratory, mastoiditis, laryngitis, dental, paranasal sinusitis, parotitis, orbital, gastrointestinal, and lip piercing 2.…”

“…Other sources include upper and lower respiratory, mastoiditis, laryngitis, dental, paranasal sinusitis, parotitis, orbital, gastrointestinal, and lip piercing 2. These infections invade to the carotid sheath and cause IJV septic thrombophlebitis within 1–3 weeks 7, 8. The most common causative organism is F. necrophorum or other Fusobacterium species 9…”

“…Metastatic septic emboli are common in lung (85%) and large joints (16–26%) 2, 3. Other metastatic diseases include soft tissue abscess, cutaneous lesions, pyomyositis, splenic and liver abscess, osteomyelitis, endocarditis, pericarditis, renal abscess, hemolytic uremic syndrome, and central nervous system complications including encephalopathy, meningitis, cerebral infarctions, epidural abscess, and brain abscess 3, 7, 8. A CT scan of the neck with i.v.…”

The Evolution of Radiological Lesions due to Septic Pulmonary Embolism

“…Thorax CT was taken under emergency conditions (Figures 1-a 1-4 , Figures 2-a [5][6][7][8][9] ) and revealed consolidations and multiple nodular lesions with various sizes (0.5-4cm) some were pleurally based and some were cavitating, randomly dispersed on both lung fields. In the lateral basal segment of the right lung lower lobe there was a wide pleural based consolidation area.…”