Left ventricular pseudoaneurysm in Lemierre’s syndrome: a case report

Abstract

Structured Abstract Background Lemierre’s Syndrome is an infectious phenomenon characterised by oropharyngeal infection with bacteraemia, thrombophlebitis and distant septic emboli. Septic emboli are a recognised cause of a type 2 myocardial infarction, with a left ventricular pseudoaneurysm being a rare but important complication of this. Case Summary A 19-year-old male presented with acute confusion, fevers and a cough. Blood cultures were positive for Fusobacterium necrophorum and initial imaging showed a cavitating pneumonia. Further evaluation revealed septic emboli in the distal digits and brain. The patient initially responded to antibiotic therapy but developed chest pain and a raised troponin. An ECG showed inferolateral ST elevation. A transthoracic echocardiogram (TTE) showed hypokinesia of the mid to apical lateral wall and a computed tomography (CT) scan showed a pericardial effusion with a possible purulent effusion or abscess. The patient underwent surgical drainage of a sterile effusion. A post-operative TTE and CT demonstrated a left ventricular pseudoaneurysm which was surgically repaired. Venous thrombus was encountered intraoperatively confirming a diagnosis of Lemierre’s Syndrome. The patient completed antibiotics and had a good postoperative recovery. Discussion This is the first case described of left ventricular pseudoaneurysm as a complication of Lemierre’s Syndrome. It highlights not only the importance of serial, multimodality imaging in both the diagnostic workup and identification of complications, but also the importance of the multidisciplinary team in the management of patients with complex and rare presentations.