Lemierre's syndrome presented with acute pancreatitis

Abstract

CaseLemierre's syndrome is a rare clinical condition that is characterized by infected internal jugular vein thrombosis with metastatic septicemia. The most common causative agent is Fusobacterium necrophorum. A previously healthy 37‐year‐old woman presented to our emergency department with nausea, vomiting, and diarrhea. She was admitted to the general practice unit with a diagnosis of acute pancreatitis then was subsequently transferred to the intensive care unit due to shock. Physical examination revealed tenderness on right side of the neck. Blood cultures were remarkable for F. necrophorum. Clinical symptoms led to subsequent ultrasound and computed tomography scan of the neck, confirming internal jugular vein thrombosis.OutcomeThe patient was treated with antibiotics for 6 weeks. Anticoagulation therapy was initiated.ConclusionWe report a case of Lemierre's syndrome that presented as acute pancreatitis. The high index of suspicion of this disease is important for early diagnosis.

Anticoagulation Strategies in the Management of Lemierre Syndrome: A Systematic Review of the Literature

“…Significant neck pain, with or without other constitutional symptoms, was described in every patient with an IJV thrombosis. 16-25,27,28 This lends credence to the notion that LS should be readily included in the differential diagnosis of pharyngitis, tonsillitis, and other infections of the oral cavity. 11 An additional evaluation of the clinical presentation of the patients included in this evaluation revealed the presence of pulmonary implications, specifically rales, wheezing, and dyspnea.…”

“…It is important to note that every case report initially began anticoagulation with an intravenous or subcutaneous medication, such as heparin, enoxaparin, or fondaparinux, though only 2 reports detailed a transition to a direct-acting oral anticoagulant (DOAC) as opposed to an outpatient regimen of enoxaparin or warfarin therapy. [16][17][18][19][20][21][22][23][24][25][26][27][28][29] Although difficult to ascertain definitive treatment regimens from the limited data available, several important distinctions can be gleaned with regard to patient presentation and the duration of anticoagulation therapy. Significant neck pain, with or without other constitutional symptoms, was described in every patient with an IJV thrombosis.…”

“…16 Based on the information and the extrapolation of data from all of the above, it may be plausible to consider 6 to 12 weeks as the ideal anticoagulation window for patients with IJV thrombosis attributed to LS. [16][17][18][19][20][21][22][23][24][25][26][27][28][29] Although not congruent in terms of pathophysiology, treatment guidance can theoretically be applied to LS from the vast amount of clinical data available for the management of venous thromboembolisms (VTEs). 30 The 2016 CHEST guidelines indicated that DOACs should be utilized rather than warfarin for select, clinically stable patients.…”

Lemierre's syndrome: One rare disease-Two case studies

“…Penicillin is a potential option if susceptibility shows sensitivity to it. [5][6][7][8][9] Metronidazole, along with a beta-lactam antibiotic for a total of 6 weeks is the recommended regimen for the management of Lemierre's syndrome. The 25-year-old female received 6 weeks of a beta-lactam antibiotic and 4 weeks of metronidazole, while the 28year-old male received 4 weeks of a beta-lactam antibiotic and 2 weeks of metronidazole.…”

“…For both cases, patients experienced septic thrombophlebitis, and no parenteral anticoagulation was initiated, as the medical team felt that management of infection was adequate. Penicillin is a potential option if susceptibility shows sensitivity to it . Metronidazole, along with a beta‐lactam antibiotic for a total of 6 weeks is the recommended regimen for the management of Lemierre's syndrome.…”