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Physical exam revealed a left-sided neck swelling from the left submaxillary region to the supraclavicular region.
Source publication
Lemièrre's syndrome (LS) is an uncommon disease characterized by septic thrombophlebitis of the jugular vein in the context of otorhinolaryngologic infections. These patients are often young and the pharyngotonsillar infection is the most frequent primary focus, but other foci like acute otitis media or otomastoiditis have been described. Although...
Contexts in source publication
Context 1
... pressure 110/50 mm Hg and heart rate 72 bpm. A leftsided neck swelling from the left submaxillary region to the supraclavicular region ( Figure 1) and deviated uvula with an area of an inflamed tonsil were noted. An otoscopy showed low secretion at left tympanic box level, slight hyperemia of the malleus and integrity of the tympanic membrane. ...
Context 2
... pressure 110/50 mm Hg and heart rate 72 bpm. A leftsided neck swelling from the left submaxillary region to the supraclavicular region ( Figure 1) and deviated uvula with an area of an inflamed tonsil were noted. An otoscopy showed low secretion at left tympanic box level, slight hyperemia of the malleus and integrity of the tympanic membrane. ...
Citations
... In the literature, case reports describing LS complicated with CVT are few (5,9,10). Therapeutic protocol include treatment with antibiotics combined with local surgical drainage and removal of the infected site, with poor outcome in half of the cases and side effects spanning from mild hearing impairment (specially in children) to iatrogenic facial palsy (10). ...
... A clinical followup three months later showed that she had completely recovered. As in previous reports (5), this is another evidence suggesting that surgical drainage is not a necessary step in all cases of LS complicated with CVT and that a conservative approach may avoid fearsome complications. ...
Lemierre's syndrome (LS) is a "forgotten" condition characterized by septic thrombophlebitis of the jugular vein that follows an otolaryngological infection. Fusobacterium necrophorum is the aetiological agent responsible for the syndrome in adolescents and young adults whereas in older people even common bacteria are involved. Complications arise from spreading of septic emboli distally, i.e. to the brain, lungs, bones and internal organs everywhere in the body. We report a middle-aged woman who presented with headache and bilateral sixth cranial nerve palsy following a sphenoidal sinusitis and left mastoiditis. Imaging revealed thrombotic involvement of the left internal jugular vein as well as of several cerebral venous sinuses thrombosis (CVT). Currently, precise management protocols of LS with CVT complication do not exist although a combination of macrolides and second or third-generation cephalosporins, as well as anti-coagulants represent the mainstream of therapeutics. Surgical drainage is associated to remove septic foci but is burdened by severe complications and side effects. Complete recovery was achieved following pharmacological treatment in our patient. This report adds further evidence that LS complicated by CVT may be effectively treated adopting a conservative approach thus avoiding surgical drainage and severe complications.
... Fusobacterium necrophorum (F. necrophorum) is the most commonly involved bacterium, but other bacteria such as Fusobacteria, Streptococcus, Staphylococcus, and Enterococcus are also found in cultures (4). Risk factors for LS are not well-known. ...
Introduction: Lemierre’s syndrome is an uncommon, life-threatening disease that develops as a severe complication of oropharyngeal infection. However, this syndrome has also been reported during anaerobic septicemia, originating from diverse sources of infection, such as the gastrointestinal system. The diagnosis of this syndrome remains challenging, and is often prompted by the detection of Fusobacterium necrophorum in blood culture, rather than with clinical signs or symptoms. Case Presentation: A previously healthy 38-year-old woman was hospitalized for a 6-day history of fever, watery diarrhea, and vomiting. Physical examination of the patient showed fever, pharyngitis, and diffuse abdominal tenderness. Laboratory investigations revealed elevated inflammatory markers, and two blood cultures revealed Fusobacterium necrophorum. An abdominal ultrasound showed a liver abscess and hepatic vein thrombosis. The thoracoabdominal and cerebral computed tomography scan confirmed the results of the abdominal ultrasound. It additionally revealed bilateral lung nodules and a parietal brain abscess. The patient’s general condition and her laboratory test results, improved after receiving treatment with ceftriaxone and metronidazole. She received antibiotics for three months, without anticoagulation therapy. Repeated computed tomography scans showed a resolution of the liver, pulmonary, and brain abscesses, as well as the recanalization of the hepatic vein. Conclusions: Lemierre’s syndrome emerges as a result of septic illness and liver abscesses in case of gastrointestinal symptoms despite the lack of common presentation.
