Gastrointestinal Variant of Lemierre Syndrome

Abstract

Fusobacterium nucleatum is a gram-negative bacillius commonly found in oropharynx and is traditionally associated with Lemierre syndrome, which is characterized by history of recent oropharyngeal infection, internal jugular vein thrombosis, and isolation of anaerobic pathogens, mainly Fuosobacterium necrophorum. However, recent evidence indicated that F. nucleatum is also a normal resident of human gut. Less than a dozen of case reports had linked F. nucleatum to gastrointestinal variant of Lemierre syndrome with portal vein thrombosis. However, F. nucleatum bacteremia-associated hepatic vein thrombosis is very rare. We report a case of a 73-year-old man who had hepatic vein thrombosis associated with F. nucleatum bacteremia, most likely from subclinical primary infection affecting the lower gastrointestinal tract. The underlying pathophysiology and treatment options are discussed here. With rapid increase in reporting of Lemierre syndrome, this case deserves particular attention from clinicians.

Severe Typhoid Fever Complicated by Superior Mesenteric and Splenic Vein Thrombosis

“…The source of infection is typically intra-abdominal and Escherichia coli is the most common pathogen isolated in blood cultures [ 26 ]; other isolated bacteria are Bacterioides spp., Streptococcus spp., and Fusobacterium spp. [ 27 , 28 ]. While diverticulitis is the most common associated infection in adult patients, in the pediatric population, pylephlebitis can be associated with umbilical vein catheterization, liver abscess, appendicitis, and enteritis.…”

A Rare Twist of the Forgotten Disease: A Case of Fusobacterium necrophorum Sepsis with Portomesenteric Thrombosis and a Review of the Literature

“…We hereby report a case of septic portomesenteric thrombosis secondary to Fusobacterium necrophorum bacteremia in the setting of sigmoid colitis to add to a total of 21 cases of Fusobacterium - spp. -infection-related pylephlebitis reported in the literature [ 8 – 27 ].…”

Pylephlebitis Caused by Fusobacterium nucleatum in a Septuagenarian Healthy Caucasian Male: Atypical Presentation of Lemierre’s Syndrome

“…All other parameters for blood were unremarkable. Urinalysis was significant for protein (1+), bacteria (2+), white blood cells (6-10), and red blood cells (5)(6)(7)(8)(9)(10). All other parameters were within normal limits.…”

“…Fusobacterium sepsis, more commonly associated with thrombophlebitis of the internal jugular vein, also known as Lemierre's syndrome, is a rare cause of pylephlebitis or other forms of thrombophlebitis outside of the head-neck syndrome, especially in the gastrointestinal system. These conditions are sometimes referred to as atypical Lemierre's syndrome [ 7 , 8 ]. In this report, we present the case of a Fusobacterium -associated thrombophlebitis of the portal vein in an otherwise healthy Caucasian male.…”