Abdominal variant of Lemierre’s Syndrome in a Patient with Pancreatic Adenocarcinoma

Abstract

Lemierre’s syndrome is an illness characterized by internal jugular vein thrombophlebitis related to infectious agents, primarily Fusobacterium necrophorum. These bacteria, residing in both the oropharynx and the gastrointestinal tract, may lead to pylephlebitis, a serious condition that could result in the development of hepatic abscesses. This manifestation of the disease is regarded as the abdominal variant of Lemierre’s syndrome. Patients with gastrointestinal malignancies, especially those who undergo surgeries, are susceptible to the abdominal variant of Lemierre’s syndrome. Timely diagnosis is required to avoid the life-threatening complications of the abdominal variant of Lemierre’s syndrome. Diffusion-weighted magnetic resonance imaging (MRI) might be very useful in differentiating this disease from liver metastasis in patients with malignancies. Radiologists and clinicians need to be aware of this challenging condition to prevent misdiagnosis, since prompt treatment is often lifesaving.

Suppurative Thrombosis of the Portal Vein (Pylephlebits): A Systematic Review of Literature

“…Articles published in languages other than English; cases where clinical, microbiological, or radiological studies did not support the diagnosis; case reports not providing an adequate amount of information, as well as those reporting non-human subjects were excluded from the analyses. The final number of articles included was 101, which resulted in total number of 103 patients [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ,…”

Pylephlebitis Complicated by Hepatic Abscesses due to Fusobacterium Nucleatum: A Case of Lemierre's Syndrome Variant and Literature Review

“…Including our case, the mean age was 51.2 years (19–69 years), with a 1:1 male-to-female ratio. Four cases 4,5,9,10 were F. necrophorum ; 3 cases 6,11,12 along with our case were F. nucleatum ; and 2 cases 7,8 were of unspecified Fusobacterium species. In our literature review, all infections were monomicrobial and community-acquired.…”

“…Keywords used in the search included Lemierre syndrome, GI-variant Lemierre syndrome, pylephlebitis, fusobacterium, and liver abscess. The search yielded 9 cases 4–12 (Table 1). Including our case, the mean age was 51.2 years (19–69 years), with a 1:1 male-to-female ratio.…”

Fusobacterium bacteremia presenting with inferior mesenteric vein thrombosis

“…The most common species isolated within this genus are F. necrophorum and F. nucleatum , the former is more commonly known to cause Lemierre's syndrome 2 . Variants of Lemierre's syndrome caused by Fusobacterium species have also been described in multiple anatomic locations such as hepatic veins, ovarian veins, suprahepatic veins, and mesenteric veins 3–6 …”