Successful perioperative management of a case of infective endocarditis secondary to a Lemierre's syndrome variant with severe neurological manifestations

Abstract

Lemierre's syndrome (LS) is characterized by septic thrombophlebitis of the internal jugular vein with septicemia and metastatic infection following an oropharyngeal infection. LS is rare but can cause infective endocarditis (IE), complicating IE management. We report a case of IE secondary to thrombophlebitis in the left vertebral vein following pharyngitis (LS variant) with distinctively severe manifestations, including metastatic infection and severe neurological impairment with multiple cerebral infarctions. A pedunculated abscess was noted on the left ventricular free wall. Despite the patient's highly impaired consciousness level (i.e., comatose state), we performed early surgery to remove the abscess after excluding LS‐related brain complications. Preoperative antibiotics included clindamycin to cover LS‐related anaerobic bacteria, and thrombophlebitis required postoperative anticoagulation. By managing LS as well as IE, the infection was controlled, and the neurological status normalized. This report provides insights into the perioperative management of IE secondary to LS.

Lemierre–like syndrome and infective endocarditis: A triumph of eponyms

“…In conclusion, Morishige and colleagues 4 must be congratulated for their comprehensive, collaborative, multidisciplinary efforts which led to the successful treatment of a rare and highly comorbid syndromic condition.…”

“…In this issue of the Journal, Morishige and colleagues 4 reported the case of an uncommon variant of this rare syndromic disease, which has an annual incidence of 3.6 cases per million people in its classic presentation 5 . The Authors presented a case which stood out under multiple standpoints: …”