Extensive thoracolumbosacral vertebral osteomyelitis after Lemierre syndrome

Abstract

Purpose To present a unique case of multilevel vertebral osteomyelitis after Lemierre syndrome. Methods A previously healthy 27-year-old man presented in the Emergency Department in septic shock because of Lemierre syndrome for which he was subsequently treated with intravenous benzylpenicillin for 2 months. Two and a half months later, the patient was readmitted with severe back pain without neurological deficits or fever. Imaging revealed an extensive vertebral osteomyelitis of the complete thoracic, lumbar and sacral spine. Results Although the blood cultures obtained at the initial admission for Lemierre syndrome revealed Fusobacterium species and Streptococcus milleri, the cultures from the spinal biopsies remained negative. Histology of the spinal biopsies showed a purulent sclerosing osteomyelitis. The patient was successfully treated with intravenous piperacillin and tazobactam. Despite persisting back pain, no recurrence of infection was seen at 3 years of follow-up. Conclusion Lemierre syndrome and an extensive thoracolumbosacral vertebral osteomyelitis are rare but serious infections. Clinicians must maintain a high index of suspicion for infectious metastases leading to vertebral osteomyelitis when a patient presents with back pain after an episode of life-threatening septicaemia caused by Lemierre syndrome.

Lemierre's Syndrome Caused by <i>Streptococcus milleri</i> Group

“…Compared to F. nechrophorum, a common bacterium, the syndrome reportedly occurs more frequently in middle-aged to older individuals (median age of onset 49 years vs. 19 years, p=0.007, IQR 36-58 years). To the best of our knowledge, this is the 15th such reported case (Table 2) (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22).…”

Paralysis: A Rare Presentation of Lemierre's Syndrome

“…Vertebral osteomyelitis is an uncommon complication from Lemierre's that can develop from contiguous spread or by hematogenous seeding of septic emboli 15,16 . Although the axial skeleton is the most frequent site of hematogenous osteomyelitis in adults, it is extremely rare in Lemierre's syndrome 15 . One case of a patient with cervical vertebral osteomyelitis presented with neck pain, fever, and dyspnea on exertion 16 .…”

Clival osteomyelitis and hypoglossal nerve palsy—rare complications of Lemierre's syndrome

“…These include septic pulmonary embolisms with cavitating pneumonia and pleural effusions 2. Septic arthritis of large joints is also common (16.5%) and extensive vertebral osteomyelitis has been documented 3. Jugular vein thrombosis can extend to involve the cavernous and sigmoid sinuses.…”