The Forgotten One: Lemierre’s Syndrome Due to Gram-Negative Rods Prevotella Bacteremia

Abstract

Patient: Male, 22Final Diagnosis: Lemierre’s syndromeSymptoms: Dyspnea • chest pain • swellingMedication: —Clinical Procedure: ThoracentesisSpecialty: Infectious DiseasesObjective:Rare co-existance of disease or pathologyBackground:Lemierre’s syndrome (LS) is a rare syndrome caused by an acute oropharyngeal infection with metastatic spreading. It was described in 1939 as jugular vein septic thrombophlebitis associated with retropharyngeal infection. Different organisms can cause LS, such as Fusobacterium species, Peptostreptococcus, group B and C, Streptococcus, Staphylococcus, and Enterococcus species, but the most commonly isolated pathogen is Fusobacterium necrophorum, a common oral flora. Management depends on the initial presentation, type of pathogen isolated, and proper selection of antibiotics.Case Report:We report a case of a 22-year-old man with no past medical history, who presented with left jaw pain and progressive left facial area swelling associated with dyspnea. A final diagnosis of LS was made based on criteria of computed tomography (CT) of the neck and the clinical symptoms. The patient was started on broad-spectrum antibiotics. Subsequent imaging of the chest showed pleural effusion with septic emboli. He underwent thoracentesis and chest tube placement. Final blood cultures were remarkable for gram-negative rods – Prevotella anaerobes – which supported the diagnosis of LS. His condition improved, including the dyspnea, and he was discharged on the proper antibiotics coverage with outpatient follow-up.Conclusions:LS is a rare condition associated with metastatic infection spreading. This syndrome can be associated with further complications, such as pleural effusions and/or empyemas. Early recognition is important to prevent fatal complications and provide adequate antibiotics coverage. We report only the third case in the medical literature of Prevotella-induced LS with a secondary complication of pleural effusion.

Infectious Cavernous Sinus Thrombosis Presenting as Temporal Arteritis—A Case Report

“…The jaw pain and scalp tenderness may be caused by the involvement of internal jugular vein with infectious thrombophlebitis and thrombosis (Figure 1C and F), as seen in Lemierre’s syndrome. 8,9 However, jaw pain should not be mistaken for jaw claudication which refers to pain in the proximal jaw that develops only after a brief period of chewing. Jaw claudication is one of the features highly specific for TA, along with diplopia and abnormality on temporal artery examination.…”

Lemierre Syndrome: Clinical Update and Protocol for a Systematic Review and Individual Patient Data Meta-analysis

“…6 Furthermore, as highlighted by our cases and in previous reports, other anaerobic or aerobic bacteria, such as Prevotella spp. (Case 1) 7,8 or Klebsiella pneumonia (Case 2), [9][10][11][12] are associated with similar clinical pictures. Whether these are truly causative agents, or F. necrophorum undetected, remains unknown.…”