Portal Vein Thrombosis Associated With Fusobacterium nucleatum Bacteremia: A Rare Abdominal Variant of Lemierre’s Syndrome

Abstract

Lemierre's syndrome is a rare but potentially severe complication of bacterial infections that usually affects previously healthy adolescents and young adults. It commonly presents as septic thrombophlebitis of the internal jugular vein and bacteremia following a recent oropharyngeal infection. The most commonly isolated organisms are Fusobacterium necrophorum, followed by Fusobacterium nucleatum and other anaerobes. Atypical Lemierre's syndrome is characterized by thrombophlebitis at sites distant from the head and neck veins and is far less encountered than typical Lemierre's syndrome. Here, we present a case of an elderly African American female with pylephlebitis, a rare abdominal variant of Lemierre's syndrome with extensive portal vein, splenic vein, and mesenteric vein thrombosis following perforated diverticulitis and resultant F. nucleatum bacteremia. She demonstrated complete recovery following appropriate long-term intravenous antibiotics and anticoagulation. This case calls attention to the re-emergence of the rare manifestation of this forgotten disease and highlights improved outcomes with prompt recognition and early treatment.

Fusobacterium bacteremia presenting with inferior mesenteric vein thrombosis

“…F. nucleatum has been shown to promote colorectal carcinogenesis through direct effects on the expression of oncogenic and inflammatory genes, as well as through suppression of host immunity 1 . Thrombosis in atypical locations warrants consideration of a hypercoagulable state (e.g., malignancy and rheumatological conditions) and colonoscopy for colon cancer and inflammatory bowel disease 1,19 …”

“…1 Thrombosis in atypical locations warrants consideration of a hypercoagulable state (e.g., malignancy and rheumatological conditions) and colonoscopy for colon cancer and inflammatory bowel disease. 1,19 Diagnosis of mesenteric vein thrombosis is based on confirmatory imaging findings of the portal vein or mesenteric vein thrombosis in the setting of systemic infection. Intravenous contrast-enhanced computerized tomography (CT), ultrasonography, or magnetic resonance imaging (MRI) can all be used to establish the diagnosis, with the former reported as the modality of choice given its availability and high sensitivity.…”

Septic thrombophlebitis of portal and splenic vein secondary to Fusobacterium nucleatum: A case report of an abdominal variant of lemierre syndrome

“…[ 1 ] Although rare, Fusobacterium has also been reported to complicate an intra-abdominal infection leading to septic thrombophlebitis of portal vein also known as pylephlebitis or abdominal variant of LS. [ 2 ] Its incidence rate is reported to be approximately 0.37 to 2.7 cases per 100,000 person years. [ 3 ] Endothelial injury, venous stasis and hypercoagulability secondary to inherited or acquired thrombophilic disorders, cirrhosis, myeloproliferative disorders, intra-abdominal inflammatory conditions, abdominal surgery or trauma, malignancy, etc, predispose to the development of portal vein thrombosis.…”