Rare case of a forgotten disease Lemierre’s Syndrome

Written by Hina Zahid Published On 2019-03-25T18:00:09+05:30 | Updated On 25 March 2019 6:00 PM IST

Dr Andrew Walkty at University of ll,Canada and colleagues have reported a case of Lamierre syndrome .The case has appeared in the NEJM.

Lemierre syndrome: is a potentially lethal form of sore throat caused by the bacterium Fusobacterium necrophorum, a common inhabitant of the mouth. This disease vanished with the advent of antibiotics but then returned decades later. It has been called the "forgotten disease."

Lemierre syndrome develops most often after a strep sore throat has created a peritonsillar abscess, a crater filled with pus and bacteria near the tonsils. Deep in the abscess, anaerobic bacteria (microbes that do not require oxygen) like Fusobacterium necrophorum can flourish. The bacteria penetrate from the abscess into the neighboring jugular vein in the neck and there they cause an infected clot (thrombosis) to form, from which bacteria are seeded throughout the body by the bloodstream (bacteremia). Pieces of the infected clot break off and travel to the lungs as emboli blocking branches of the pulmonary artery bringing the heart's blood to the lungs. This causes shortness of breath, chest pain and severe pneumonia.

The keys to survival with Lemierre syndrome are prompt recognition of the disease, immediate use of antibiotics (to which the bacterium is responsive), and drainage of abscesses. Even with prompt appropriate therapy, the mortality (death) rate is 4 to 12%.

The syndrome was first described by A. Lemierre in the English medical journal The Lancet in 1936.

An 18-year-old man presented to the emergency department with a 1-week history of sore throat, fever, and malaise and a 3-day history of pleuritic chest pain and productive cough. He reported no history of intravenous drug use, recent travel, or known sick contacts. On examination, he was febrile and ill-appearing and had an oxygen saturation of 88% while breathing ambient air.

A chest radiograph showed consolidation in the middle and upper portions of the left lung, and computed tomography of the chest revealed multiple cavitary lesions (Panel A) and a loculated left pleural effusion. An anaerobic blood culture obtained at the time of admission grew Fusobacterium necrophorum (Panel B). Contrast-enhanced computed tomography of the neck revealed an intraluminal filling defect in the right internal jugular vein, a finding suggestive of thrombus (Panel C, arrow). Lemierre’s syndrome was diagnosed.

Lemierre’s syndrome is characterized by thrombophlebitis of the internal jugular vein and evidence of disseminated infection (often septic pulmonary emboli), typically after a recent oropharyngeal infection. The patient underwent drainage of the pleural effusion and received intravenous ceftriaxone and oral metronidazole. At follow-up after the completion of antimicrobial therapy, he had recovered well.

For more details click on the link: DOI: 10.1056/NEJMicm1808378

breathing ambient airComputed tomographycoughemergency departmentforgotten diseaseFusobacterium necrophorumLemierre’s syndromeMalaiseoral metronidazoleoxygenpleuritic chest painrare case

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Hina Zahid