Clinical communicationsLemierre syndrome
Introduction
Prompt recognition and treatment of postanginal sepsis or Lemierre syndrome, a disease with distinct clinical features, is essential to avoid morbidity and mortality. In 1936, Lemierre described a syndrome with characteristic elements of oropharyngeal infection, sepsis, internal jugular vein thrombosis, and septic emboli caused by Fusobacterium necrophorum (1, 2). In the pre-antibiotic era, the disease was rapidly progressive and fatal in 90% of cases (3). The disease is currently seen less frequently but mortality is still estimated at 8–15% despite antibiotic therapy (4, 5). When the clinical features of the disease are encountered, a low threshold for instituting anaerobic antibiotic coverage may be life-saving. We present a case of Lemierre syndrome treated successfully with clindamycin.
Section snippets
Case report
A 15-year-old, previously healthy girl presented to the emergency department (ED) with pallor, confusion, and rigors after 2 days of fever to 40.0°C, sore throat, vomiting and myalgias. Rapid streptococcal antigen test and throat culture obtained the day before admission were negative.
Upon presentation, the blood pressure was 72/55 mm Hg, pulse 159 beats per minute, respirations 23 breaths per minute, and oral temperature 38.1°C. The patient appeared ill and diaphoretic. She had bilateral
Discussion
The classic presentation of Lemierre syndrome involves a previously healthy adolescent or young adult who develops anaerobic septicemia 3–5 days after primary oropharyngeal, tonsillar or peritonsillar infection that initially may not be clinically impressive (6). Patients often then develop painful swelling and tenderness of the lateral aspect of the neck due to septic thrombophlebitis of the internal jugular vein (1, 2, 5). Septic emboli may spread from the internal jugular vein and most often
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Cited by (27)
Lemierre syndrome from a neck abscess due to methicillin-resistant Staphylococcus aureus
2013, Brazilian Journal of Infectious DiseasesCitation Excerpt :On a recent review of 114 cases of Lemierre syndrome, the pooled mortality was 5%.10 There appears to be an increase in Lemierre syndrome cases, perhaps due to antibiotic resistance or changes in antibiotic prescription patterns.8 In conclusion, a high index of suspicion is important for timely diagnosis and prompt initiation of appropriate antibiotics, including anaerobic coverage, is essential to decrease the morbidity and mortality associated with Lemierre syndrome.
Lemierre syndrome and influenza A (H1N1)
2011, Archives de PediatrieLemierre's syndrome
2010, Annales Francaises d'Anesthesie et de ReanimationAn unusual case of lemierre's syndrome due to methicillin-resistant staphylococcus aureus
2010, Journal of Emergency MedicineCitation Excerpt :Metastatic infection in the lungs results in infiltrates, abscesses, cavitations, empyema, and effusions. Other common findings include septic arthritis and hepatic and renal abscesses (7). ED treatment begins with appropriate diagnosis followed by broad-spectrum antibiotic therapy.
Diagnosis of lemierre syndrome by bedside emergency department ultrasound
2010, Journal of Emergency MedicineLemierre syndrome
2010, Presse Medicale
Clinical Communications (Pediatrics) is coordinated by Roger Barkin, md, of HealthONE, Denver, Colorado and Ghazala Q. Sharieff, md of the University of California, San Diego, California