Septic thrombophlebitis of the internal jugular vein, a case of Lemierre's syndrome

Alperstein, Adam; Fertig, Raymond; Feldman, Matthew; Watford, Daniel J; Nystrom, Susan; Delva, Guesly; Muddassir, Salman

doi:10.5582/irdr.2017.01021

Cited by 18 publications

(36 citation statements)

References 13 publications

(14 reference statements)

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“…In 1936, André Lemierre, described a disease complex that combined anaerobic and septic bacterial infections after tonsillitis. [7][8][9][10] Lemierre's illustration focused on septicemia after angina caused by Fusobacterium necrophorum, describing a progression from suppurative peritonsilar infection, through thrombophlebitis of the internal jugular vein, to septic embolization of distant sites, such as the lungs. 11 The most common site of infection is the palatine tonsils (87.1% of cases).…”

Section: Discussionmentioning

confidence: 99%

“…4,5 The syndrome primarily affects young adults 6 and can potentially be fatal. 1,2,4,7 Lemierre syndrome is also known as the "forgotten disease", because of its rarity. 7 It has an incidence of around 3.6 million people per year, 2 with mortality of around 5%, when diagnosed.…”

Section: Introductionmentioning

confidence: 99%

“…1,2,4,7 Lemierre syndrome is also known as the "forgotten disease", because of its rarity. 7 It has an incidence of around 3.6 million people per year, 2 with mortality of around 5%, when diagnosed. 5,8 Treatment is basically founded on antibiotic therapy tailored to the pathogen involved and surgery is rarely needed.…”

Section: Introductionmentioning

confidence: 99%

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Síndrome de Lemierre: relato de caso

et al. 2018

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Lemierre syndrome is characterized by septic thrombophlebitis of the internal jugular vein, after an oropharyngeal infection, with septic embolization to the lungs or other organs. This case report describes a 37-year-old female patient who presented with edema and pain in the right hemiface with onset 3 days previously and progressive fatigue and dyspnea since the previous day. She had had tooth 48 extracted 3 days previously. Physical examination at admission found tachypnea, with 60% saturation (in room air), edema at the angle of the right mandible, diffuse reduction of vesicular murmur, and calves free from clubbing. Angiotomography of the chest and laboratory tests were compatible with septic emboli, and cervical computed tomography confirmed a diagnosis of septic thrombophlebitis of the internal jugular vein. She was managed with antibiotics and given treatment for her symptoms. Lemierre syndrome most often occurs in young men and there is embolization to the lungs in up to 97% of cases. Rarely, the etiology of this syndrome may be tooth extraction. Computed tomography is the imaging method most often used for diagnosis and treatment is basically antibiotic. Surgery is thus rarely necessary.A síndrome de Lemierre caracteriza-se pela tromboflebite séptica da veia jugular interna, após uma orofaringite, com embolização séptica para o pulmão ou outros órgãos. Neste relato de caso, apresentamos uma paciente feminina, 37 anos de idade, com história de edema e dor em hemiface direita há três dias, associada a fadiga e dispneia progressiva há um dia. História de extração dentária do elemento 48 há três dias. No exame físico admissional, apresentava-se taquipneica, saturando 60% (em ar ambiente), com edema em ângulo da mandíbula direita, redução difusa do murmúrio vesicular e panturrilhas sem empastamento. Angiotomografia de tórax e exames laboratoriais foram compatíveis com quadro de embolia séptica, e tomografia computadorizada da cervical corroborou o diagnóstico de tromboflebite séptica da veia jugular interna. Foi tratada com antibióticos e sintomáticos. A síndrome de Lemierre afeta mais homens jovens e tem embolização para o pulmão em até 97% dos casos. Extrações dentárias raramente podem ser a etiologia dessa síndrome. A tomografia computadorizada é o método de imagem mais utilizado no diagnóstico, e o tratamento é, essencialmente, com antibióticos; portanto, a abordagem cirúrgica é raramente necessária.Palavras-chave: síndrome de Lemierre; extração dentária; tromboflebite; embolia pulmonar. Lemierre syndrome: case report 338 338/340 J Vasc Bras. 2018, Out.-Dez.; 17(4):337-340

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Síndrome de Lemierre: relato de caso

et al. 2018

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“…The causative bacteria can penetrate, either through the lymphatic system or along the fascial planes, into the adjacent blood vessels causing thrombosis and subsequent thrombophlebitis of the internal jugular vein, often forming parapharyngeal inflammation and a peritonsillar abscess along the way. The presence of haemagglutinin promotes the fulminant nature of the disease by augmenting platelet aggregation and septic thrombus formation 2. The propagation of the septic emboli throughout the body causes a cascade of disastrous effects, most commonly lodging into the lungs and creating cavitary lesions.…”

Section: Descriptionmentioning

confidence: 99%

Lemierre’s syndrome: cavitary lung disease caused by uncommon bacteria

et al. 2018

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“…Gastrointestinal symptoms are not uncommon however are rarely recorded as sole presenting complaint 2. There are only few recorded cases of patients presenting with solely gastrointestinal symptoms in the absence of throat symptoms.…”

Section: Introductionmentioning

confidence: 99%

Lemierre’s syndrome: a rare cause of sepsis presenting with an absence of throat symptoms

2018

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A 16-year-old boy presented to hospital with a 6-day history of diarrhoea, vomiting and abdominal pain. During his admission he was found to be hypotensive, tachycardic and persistently feverish. Blood cultures taken on admission isolated CT scanning of his neck showed a non-occlusive thrombus of the right internal jugular vein and a small right parapharyngeal abscess. CT scans of the chest and abdomen revealed multiple pulmonary abscesses, bilateral pleural effusions and splenomegaly. Treatment consisted of an unfractionated heparin infusion and intravenous antibiotics. A right-sided intercostal drain was inserted for a complex right-sided empyema. He subsequently developed a left-sided pleural effusion which was treated with a video-assisted thoracoscopic surgery (VATS) pleurodesis procedure. His fever resolved after his VATS pleurodesis procedure 3 weeks after initial presentation. Clinically he made a slow recovery but now is improved after 6 weeks of intravenous antibiotics and was discharged home.

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Septic thrombophlebitis of the internal jugular vein, a case of Lemierre's syndrome

Cited by 18 publications

References 13 publications

Síndrome de Lemierre: relato de caso

Síndrome de Lemierre: relato de caso

Lemierre’s syndrome: cavitary lung disease caused by uncommon bacteria

Lemierre’s syndrome: a rare cause of sepsis presenting with an absence of throat symptoms

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