Atypical Lemierre’s syndrome. A case report and review of Literature

Qureshi, A.; Bailey, T. B.; Atkinson, Michael; Tayabali, Khadija

doi:10.55729/2000-9666.1006

Cited by 2 publications

(4 citation statements)

References 11 publications

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“…Heightened suspicion should arise when oropharyngeal pharyngitis or periodontal abscess persists beyond 3 to 5 days and is accompanied by systemic or respiratory symptoms, lateral cervical pain, dysphagia, progression to sepsis or multiple pulmonary abscesses (5,8,9,11) The common presentation of LS is unilateral neck discomfort and in ammation at the anterior border of the sternocleidomastoid muscle after a recent throat infection (3,12). The detection of this syndrome may be easily overlooked or delayed since patients typically exhibit a palpable, tender cord (or 'cord sign') of the internal jugular vein in only 26% to 45% of cases (1,3,8,13). Furthermore, microbiology laboratories often encounter challenges in cultivating Fusobacterium necrophorum, as observed in our case.…”

Section: Discussionmentioning

confidence: 99%

“…Given the occurrence of beta-lactamase-producing Fusobacterium. For necrophorum strains resistant to macrolides and penicillin (6,26), the literature recommends the use of a beta-lactamase-resistant beta-lactam antibiotic in conjunction with metronidazole, which is initially advised for two weeks, transitioning to metronidazole alone for six weeks (13,14). This approach ensures deep penetration into brin clots and addresses potential resistance issues.…”

Section: Discussionmentioning

confidence: 99%

“…Despite these challenges, a consensus among several authors advocates for the utilization of anticoagulation therapy in LS patients as a strategy to mitigate neurological complications. This underscores the importance of a tailored approach that weighs the estimated risk of venous thromboembolism against potential contraindications (5,6,13,14). Speci cally, the deployment of anticoagulant therapy is recommended for patients identi ed as high risk, emphasizing a judicious evaluation of bene ts and risks (28,29).…”

Section: Discussionmentioning

confidence: 99%

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Lemierre's Syndrome: Atypical Presentation of the Internal Carotid Artery and Jugular Vein Fistula—CaseReport and Review

Kariuki,

Musabyemungu,

kebedi

et al. 2024

Preprint

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Background: Lemierre's syndrome (LS) is a rare yet potentially life-threatening complication of oropharyngeal infections that is typically characterized by septic thrombophlebitis of the internal jugular vein and is commonly associated with Fusobacterium necrophorum. Despite its recognition since 1936, LS can present atypically, as seen in our case where a patient exhibited a rare complication of an internal carotid artery and jugular vein fistula. This case highlights the diagnostic and therapeutic challenges that can arise and underscores the importance of both a broader awareness of LS and the necessity for a multidisciplinary approach. Case Presentation: A 42-year-old male who was initially diagnosed with a periodontal abscess and tonsillitis later developed internal jugular vein thrombophlebitis. This progressed to an internal carotid to internal jugular vein fistula, leading to septic thrombosis of the left internal carotid and jugular vein and eventually culminating in a carotid bulb aneurysm and subsequent cerebral infarct. The patient also experienced septic emboli, resulting in lung and mediastinal abscesses. Treatment involved intravenous antibiotics, anticoagulant therapy, and vascular repair, yielding a favorable outcome. Conclusions: This case underscores the intricate nature of LS, showing its potential to progress to severe septic complications, including rare vascular issues and cerebral infarction. The diagnostic complexities and therapeutic interventions emphasize the critical importance of early identification, prompt diagnosis, and multidisciplinary management of LS to prevent life-threatening outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Lemierre's Syndrome: Atypical Presentation of the Internal Carotid Artery and Jugular Vein Fistula—CaseReport and Review

Kariuki,

Musabyemungu,

kebedi

et al. 2024

Preprint

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“…Surgical treatments, such as drainage of abscesses and debridement of tissues, may be required for the treatment of LS [ 4 ]. Postoperative limitations in the mobility of the neck have been reported in some cases [ 5 , 6 ]; however, reports of atelectasis have been infrequent [ 7 , 8 ]. The lungs do not expand sufficiently in some patients, resulting in abscess formation and deterioration [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of Physical Therapy on a Patient With Lemierre's Syndrome Who Had Atelectasis and Limited Range of Motion in the Neck

Onozawa,

Someya,

Yokogawa

2023

Cureus

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Lemierre's syndrome (LS) is a severe infectious disease that can lead to the formation of neck abscesses and thrombosis. LS may be an indication for surgery; however, there are few reports on the physical therapy approaches used in patients with LS. A male patient in his 20s reported atelectasis and limited range of motion in the neck after resection of a deep neck abscess on the left side of the neck caused by LS. Thrombophlebitis was also observed around the neck lesion, indicating the risk of pulmonary embolism. Physical therapy was initiated with low-load, deep breathing exercises. Additional breathing exercises, such as respiratory assistance and positive pressure loading, were initiated after the administration of anticoagulants. Although the therapeutic intervention was delayed due to the unstable wound with partially resected muscle, it was assumed that the impairment of the range of motion in the neck was unlikely to persist as the patient was young. No critical adverse events were observed, and the range of motion was recovered such that the patient was able to resume playing baseball. The presence of a venous thrombus and inflammation may affect physical therapy; however, careful management of the exercise load could aid in the safe and effective treatment of LS without the incidence of complications, even in the early postoperative period.

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Atypical Lemierre’s syndrome. A case report and review of Literature

Cited by 2 publications

References 11 publications

Lemierre's Syndrome: Atypical Presentation of the Internal Carotid Artery and Jugular Vein Fistula—CaseReport and Review

Lemierre's Syndrome: Atypical Presentation of the Internal Carotid Artery and Jugular Vein Fistula—CaseReport and Review

Effects of Physical Therapy on a Patient With Lemierre's Syndrome Who Had Atelectasis and Limited Range of Motion in the Neck

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