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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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“…Thus, symptoms mimic other common diseases. Botros et al 8 have described this dilemma in an excellent manner.…”

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%

Lemierre’s syndrome: current perspectives on diagnosis and management

Johannesen

Bødtger

2016

IDR

138

160

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“…Moreover, multi-organ involvement is already present at diagnosis, with over 80% of patients displaying septic embolism, especially pulmonary, musculoskeletal, or intracranial [18]. As a consequence, differential diagnosis is usually complex; depending on the dominant features at presentation, it may include conditions ranging from relatively common conditions such as streptococcal pharyngitis, viral infection (infectious mononucleosis, CMV), septic arthritis, meningitis, or community-acquired pneumonia [27,28] Frequently, the diagnosis is only considered after the incidental isolation of Fusobacterium necrophorum, which may lead to potentially clinically relevant delay of the appropriate management [33]. Therefore, a high index of suspicion is necessary to diagnose Lemierre syndrome.…”

Section: Clinical Presentation Prognosis and Treatmentmentioning

confidence: 99%

Lemierre syndrome: Current evidence and rationale of the Bacteria-Associated Thrombosis, Thrombophlebitis and LEmierre syndrome (BATTLE) registry

Valerio

Corsi

Sebastian

2020

Thrombosis Research

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Lemierre syndrome is a rare but potentially fatal condition characterized by septic thrombophlebitis of the head and neck district, preferentially affecting adolescents and young adults and manifesting as a complication of a local bacterial infection-typically, a pharyngotonsillitis or an abscess. It is historically associated with the Gram-negative anaerobic rod Fusobacterium necrophorum and with thrombophlebitis of the internal jugular vein. However, its definition has never been firmly established, and its spectrum within the continuum of bacteriaassociated thrombophlebitis may be larger than what presumed so far. Recent evidence suggests that its prognosis remains serious even one hundred years after its first description, with considerable rates of in-hospital complications, death, and long-term sequelae. There are no specific guidelines on its management other than usual antibiotic stewardship, with ongoing debate on the potential role of therapeutic-dose anticoagulation. We provide an overview of current evidence on the definition, epidemiology, clinical presentation, prognosis and management of this condition and present the background and rationale of the Bacteria-Associated Thrombosis/Thrombophlebitis and LEmierre syndrome (BATTLE) registry: an ambispective, disease-specific, non-population based, multicentre clinical registry of global reach and multidisciplinary scope, specifically designed to address the limitations of current evidence and to provide patients and physicians with clinically viable information to guide management and improve the outcomes of those affected by these conditions.

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“…He uses pathophysiologic reasoning to refine the differential diagnosis and direct further history. 4 Upon further questioning, the patient denied joint or sinus symptoms, but recalled a non-blanching, nonpruritic erythematous rash over the anterior and posterior surfaces of his calves on two occasions within the previous 6 months (Fig. 2).…”

mentioning

confidence: 99%