Carotid artery stenoses and thrombosis secondary to cavernous sinus thromboses in Fusobacterium necrophorum meningitis

Abstract

Summary: We report the case of a young man with Fusobacterium necrophorum meningitis who developed bilateral carotid artery stenosis associated with thrombosis of the cavernous sinuses.Intraluminal clot was present in the region of the stenoses for which he was anticoagulated. The clinical presentation, problems with diagnosis, the use of anticoagulation and the need for prolonged treatment with metronidazole are discussed.

Human Infection withFusobacterium necrophorum(Necrobacillosis), with a Focus on Lemierre's Syndrome

“…Bacterial sepsis (etiology unspecified) was identified as a risk factor in 4% of these. Sinovenous thrombosis is a recognized complication of F. necrophorum infection (20,211,370). In the current literature review, 15/251 patients with F. necrophorum infection had venous sinus thrombophlebitis; these patients ranged in age from 11 months to 38 years, with a median age of 15 years.…”

Methicillin-Resistant Staphylococcus aureus USA300 Clone as a Cause of Lemierre's Syndrome

“…Other studies report harm from anticoagulation (15,19). Involvement of the cavernous sinus is generally regarded as an indication for anticoagulation (9,17). One review found that the use of intravenous heparin, followed by 3 months of warfarin, reduced morbidity among survivors (12).…”

Fusobacterium necrophorum infection associated with portal vein thrombosis

“…This is usually pharyngeal or tonsillar but foci in the face, ears, sinuses, mastoid and teeth have also been described (Hagelskjaer Kristensen & Prag, 2000). In addition there are reports of F. necrophorum meningitis complicated by thrombosis of the cerebral veins (Larsen et al, 1997) or cavernous sinus (Jones et al, 1990). Thrombosis is most probably due to the ability of F. necrophorum to cause platelet aggregation as has been demonstrated in vitro (Forrester et al, 1985;Kanoe et al 1989).…”