Fusobacterium necrophorum‐induced sepsis: an unusual case of Lemierre's syndrome

Abstract

Classical Lemierre's syndrome is characterized by severe sepsis with metastatic abscess formation in young, previously fit people from a primary head or neck focus. The causative organisms are the anaerobic fusobacteria, most commonly Fusobacterium necrophorum. We describe the evaluation, therapeutic interventions and management of a patient with Lemierre's syndrome who presented in septic shock with multiple organ dysfunction. The patient required immediate interventions including endotracheal intubation and mechanical ventilation, fluid resuscitation, inotropic support, bilateral thoracostomy tube drainage of empyemata and antimicrobial therapy. The unexpected isolation of Fusobacterium necrophorum from blood cultures and empyema fluid necessitated a change of antibiotic regime to provide anaerobic cover. The patient required 4 weeks of intensive support including prolonged antimicrobial therapy, and after a further 2 weeks was discharged home from hospital. This case highlights the need to raise the awareness of 'the forgotten disease': Lemierre's syndrome. Its diagnosis may, as in this case, be confounded by a lack of symptoms of pharyngitis at the time of presentation, and end-organ dysfunction associated with severe sepsis, possibly suggesting an alternative source of infection. As appropriate antibiotics reduce mortality dramatically, clinicians need to be alert to Lemierre's syndrome and include it in the differential diagnosis in young but otherwise healthy patients presenting with severe sepsis.

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

“…The key distinguishing features are the fact that lung involvement in Lemierre's syndrome is preceded by sore throat and may be accompanied by internal jugular vein thrombosis and that initially lung lesions consist of multiple diffusely disseminated nodular lesions which rapidly cavitate. Not infrequently patients present with hemoptysis (79,166,230,327), which can cause further diagnostic confusion. Jensen et al (208) highlighted the fact that F. necrophorum can cause false-positive results in Mycoplasma pneumoniae 16S rRNAPCR tests.…”

A case of Lemierre syndrome

“…The blood count usually shows leukocytosis and a few cases exhibiting thrombocytopenia have been noted. Renal insufficiency with hematuria, pyuria, proteinuria, and/or a rise in blood urea may result from kidney involvement 3151834. Coagulopathy and disseminated intravascular coagulation also has been reported 31.…”

Dental phobia resulting in life threatening sepsis: Lemierre's syndrome complicated by acute cardiomyopathy

“…Other reported complications include meningitis, osteomyelitis of the atlas, carvernous sinus thrombosis, sigmoid sinus thrombosis, opthalamic vein thrombosis with ocular proptosis, and inferior vena cava thrombosis [12 Á/14]. Difficulty in establishing the diagnosis in a septic patient may occur due to the absence of oropharyngeal signs and symptoms [15]. An unusual feature of the fusobacteria species is the promotion of venous thromboses by stimulating increased platelet aggregation [16Á/18].…”