The co-existence of Lemierre's syndrome and Bezold's abscesses due to Streptococcus constellatus

Abstract

Rationale:The ancient infectious diseases, Lemierre's Syndrome and Bezold's Abscesses are rare.Patient concerns:A 70-year-old Japanese woman with a 15-year history of Parkinson's disease was referred to our hospital due to fever, occipital headache and bilateral shoulder pain that had continued for three months. She had been prescribed prednisolone due to a diagnosis of polymyalgia rheumatica.Diagnoses:A blood culture revealed bacteremia of Streptococcus constellatus. In addition, computed tomography revealed Bezold's abscesses and Lemierre's syndrome.Interventions:We administered ceftriaxone for 31 days, followed by oral amoxicillin.Outcomes:The patient recovered and the abscesses improved.Lessons:This case underscores the importance of blood culture tests and cross-referencing with radiological imagings in the diagnoses of these rare critical infectious diseases that mimic polymyalgia rheumatica.

Lemierre's Syndrome Caused by <i>Streptococcus milleri</i> Group

“…Compared to F. nechrophorum, a common bacterium, the syndrome reportedly occurs more frequently in middle-aged to older individuals (median age of onset 49 years vs. 19 years, p=0.007, IQR 36-58 years). To the best of our knowledge, this is the 15th such reported case (Table 2) (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22).…”

A Systematic Review of Cases with Bezold’s Abscess

“…Additionally, it has been postulated that pathogens may travel directly through eroded bone or via the small venules arising from the mastoid and ascend intracranially to the dural sinuses (51,52). Although this otologic complication is not specific to Bezold’s abscess, 10 patients in the current review manifested with dural sinus thrombosis (13,15,24,26,33,37,38,47–49). This is an important complication for clinicians to be aware of due to the potentially devastating sequelae, as demonstrated by one patient who developed a right-sided cerebellar infarction (48).…”

“…Although this otologic complication is not specific to Bezold’s abscess, 10 patients in the current review manifested with dural sinus thrombosis (13,15,24,26,33,37,38,47–49). This is an important complication for clinicians to be aware of due to the potentially devastating sequelae, as demonstrated by one patient who developed a right-sided cerebellar infarction (48). Other complications include seizures, cerebral herniation, and permanent cognitive deficits (53).…”

“…Of manuscripts written in non-English language, three had no abstracts available, and five provided abstracts with insufficient data regarding baseline demographics, clinical presentation, and management. Finally, 45 studies were included in this systematic review, with 49 patients being pulled from case reports or series (1,3,8–50).…”

“…Initial antibiotic therapy should offer broad coverage since infections were found to often be polymicrobial in nature, and may be narrowed after information on sensitivities and strains are acquired. Increasing the range of coverage may be necessary with the development of severe complications, including Lemierre's syndrome, thoracic necrotizing fasciitis, paraspinal abscess, or dural sinus thrombosis (33,44,47,48,50). Additionally, newer antibiotic options reduce the renal and audiovestibular risks of aminoglycosides.…”