Lemierre syndrome: a rare complication of pharyngotonsillitis

Noh, Han-Jin; Freitas, Claudia Antunha de; Souza, Rafael de Paula e Silva Felici de; Simões, Juliana Caminha; Kosugi, Eduardo Macoto

doi:10.1016/j.bjorl.2015.03.009

Cited by 14 publications

(7 citation statements)

References 5 publications

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“…The most commonly involved bacteria is Fusobacterium necrophorum but other bacteria such as fusobacteria, Streptococcus, Staphylococcus , and Enterococcus are commonly found in cultures. 2 Other bacteria, such as Klebsiella Pneumoniae have rarely been described in middle-aged persons with newly diagnosed type 2 diabetes. 3…”

Section: Definitionmentioning

confidence: 99%

“… 4 Patients are often young (age 16–30 years) and otherwise healthy, but appear acutely ill with tachycardia, tachypnea, hypotension, and a poor saturation (often <95%). 2 , 3 , 5 , 6 Laboratory findings showed leukocytosis with dominating neutrocytosis and elevated C-reactive protein as well as signs of organ failure, such as elevated liver enzymes. Imaging of the internal jugular vein showed thrombosis.…”

Section: Definitionmentioning

confidence: 99%

“…This review yielded at total number of 137 cases 2 , 3 , 5 , 6 , 8 , 10 – 90 including both case reports and minor reviews. The major clinical characteristics of LS are reported in Table 1 .…”

Section: Diagnosismentioning

confidence: 99%

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Lemierre’s syndrome: current perspectives on diagnosis and management

Johannesen

Bødtger

2016

IDR

130

143

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This is a systematic review of cases with Lemierre’s syndrome (LS) in the past 5 years. LS is characterized by sepsis often evolving after a sore throat or tonsillitis and then complicated by various septic emboli and thrombosis of the internal jugular vein. Symptoms include sepsis, pain, and/or swelling in the throat or neck, as well as respiratory symptoms. Laboratory findings show elevated infectious parameters and radiological findings show thrombosis of the internal jugular vein and emboli in the lungs or other organs. The syndrome is often associated with an infection with Fusobacterium necrophorum. We found a total of 137 cases of LS, of which 47 were infected with F. necrophorum and others with Staphylococcus and Streptococcus. Complications of this rare but severe disease included osteomyelitis, meningitis, and acute respiratory distress syndrome. Mortality was extremely high in the pre-antibiotic era but has diminished with the advent of antibiotics. This review showed a mortality rate of only 2% of which none of the cases involved fusobacteria. Duration of treatment varied; a 4–6-week course of carbapenem or piperacillin/tazobactam in combination with metronidazole was optimum. Other treatment options included anticoagulants in 46% of cases, which is unwarrantedly high, as to date, no evidence of the positive effects of anticoagulants in LS exists. Only two cases had ligation of the internal jugular vein performed. This review confirms the rare, but severe aspects of LS. Mortality from LS in this day and age appears to be low, however the syndrome is difficult to recognize, and still requires the full attention of the clinician.

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Section: Definitionmentioning

confidence: 99%

Section: Definitionmentioning

confidence: 99%

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Lemierre’s syndrome: current perspectives on diagnosis and management

Johannesen

Bødtger

2016

IDR

130

143

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“…Noh et al however, reported septic pulmonary embolus in their case report. 4 In the times of COVID-19, remaining free of infection was a challenge for a critically ill patient with prolonged stay as the risk of acquiring nosocomial infection was high and also the prognosis in such patients was not favorable. In case the patient turned positive, he would need to be treated in a different isolation ward and operation theatre with no attendants.…”

Section: Discussionmentioning

confidence: 99%

The challenges of a Lemierre’s syndrome in COVID-19 times

Bhat

Lalitha

Desai

et al. 2020

Int J Otorhinolaryngol Head Neck Surg

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<p>Lemierre’s syndrome is a type of necrotizing fasciitis of the head and neck that is an uncommon rapidly spreading infection involving the skin, subcutaneous tissue and the fascia leading to life-threatening complications like septicaemia, bone marrow suppression, disseminated intravascular coagulation and multi-organ failure. The management of this disease, especially in COVID-19 pandemic is a challenge as it is associated with high morbidity. A 46-year-old male presented to us with complaints of swelling in the neck with discoloration of skin in the neck and chest. Computed tomography (CT) scan of the neck revealed thrombosis of the right internal jugular vein (IJV) and diffuse abscesses on both sides of the neck. A high index of suspicion is required for the diagnosis of Lemierre’s syndrome in the absence of typical clinical features. The rapid, unpredictable dissemination of infection and occult thrombus within the IJV make both diagnosis and management a challenge especially, during COVID-19 times.</p>

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“…The first line treatment for LS is intravenous antimicrobial therapy, 4 with coverage for anaerobic microbes. 6,10,13 Response to antibiotics is slow and the average time between start of treatment and resolution of fever varies from 8 to 12 days. 9,10 Surgical exploration with ligature and excision of thee internal jugular vein is rarely necessary, but may be indicated in cases with persistent septic emboli or for surgical drainage of abscesses or pulmonary empyema.…”

Section: Discussionmentioning

confidence: 99%

Síndrome de Lemierre: relato de caso

et al. 2018

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Lemierre syndrome is characterized by septic thrombophlebitis of the internal jugular vein, after an oropharyngeal infection, with septic embolization to the lungs or other organs. This case report describes a 37-year-old female patient who presented with edema and pain in the right hemiface with onset 3 days previously and progressive fatigue and dyspnea since the previous day. She had had tooth 48 extracted 3 days previously. Physical examination at admission found tachypnea, with 60% saturation (in room air), edema at the angle of the right mandible, diffuse reduction of vesicular murmur, and calves free from clubbing. Angiotomography of the chest and laboratory tests were compatible with septic emboli, and cervical computed tomography confirmed a diagnosis of septic thrombophlebitis of the internal jugular vein. She was managed with antibiotics and given treatment for her symptoms. Lemierre syndrome most often occurs in young men and there is embolization to the lungs in up to 97% of cases. Rarely, the etiology of this syndrome may be tooth extraction. Computed tomography is the imaging method most often used for diagnosis and treatment is basically antibiotic. Surgery is thus rarely necessary.A síndrome de Lemierre caracteriza-se pela tromboflebite séptica da veia jugular interna, após uma orofaringite, com embolização séptica para o pulmão ou outros órgãos. Neste relato de caso, apresentamos uma paciente feminina, 37 anos de idade, com história de edema e dor em hemiface direita há três dias, associada a fadiga e dispneia progressiva há um dia. História de extração dentária do elemento 48 há três dias. No exame físico admissional, apresentava-se taquipneica, saturando 60% (em ar ambiente), com edema em ângulo da mandíbula direita, redução difusa do murmúrio vesicular e panturrilhas sem empastamento. Angiotomografia de tórax e exames laboratoriais foram compatíveis com quadro de embolia séptica, e tomografia computadorizada da cervical corroborou o diagnóstico de tromboflebite séptica da veia jugular interna. Foi tratada com antibióticos e sintomáticos. A síndrome de Lemierre afeta mais homens jovens e tem embolização para o pulmão em até 97% dos casos. Extrações dentárias raramente podem ser a etiologia dessa síndrome. A tomografia computadorizada é o método de imagem mais utilizado no diagnóstico, e o tratamento é, essencialmente, com antibióticos; portanto, a abordagem cirúrgica é raramente necessária.Palavras-chave: síndrome de Lemierre; extração dentária; tromboflebite; embolia pulmonar. Lemierre syndrome: case report 338 338/340 J Vasc Bras. 2018, Out.-Dez.; 17(4):337-340

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Lemierre syndrome: a rare complication of pharyngotonsillitis

Cited by 14 publications

References 5 publications

Lemierre’s syndrome: current perspectives on diagnosis and management

Lemierre’s syndrome: current perspectives on diagnosis and management

The challenges of a Lemierre’s syndrome in COVID-19 times

Síndrome de Lemierre: relato de caso

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Lemierre syndrome: a rare complication of pharyngotonsillitis

Cited by 14 publications

References 5 publications

Lemierre&rsquo;s syndrome: current perspectives on diagnosis and management

Lemierre&rsquo;s syndrome: current perspectives on diagnosis and management

The challenges of a Lemierre’s syndrome in COVID-19 times

Síndrome de Lemierre: relato de caso

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Resources

About

Lemierre’s syndrome: current perspectives on diagnosis and management

Lemierre’s syndrome: current perspectives on diagnosis and management