At 3 months of follow-up, the brain MRI lesions had resolved and the patient presented residual mild left hemiparesis.Discussion We present a case of multiple brain abscesses distributed in watershed regions in a patient with acute left otomastoiditis [elsevier.es]

Keywords Lemierre's syndrome;Fusobacterium necrophorum Abstract We present the case of a 19 year male who presented initially with acute otitis media and mastoiditis that subsequently evolved into Lemierre’s syndrome. [ommegaonline.org]

We present a case of Lemierre’s syndrome complicated by an epidural abscess. [priory.com]

Review the presentation of a patient with Lemierre syndrome. Outline the treatment and management options available for Lemierre syndrome. [statpearls.com]

On presentation she was tachycardic, hypotensive and had an exam notable for granular pharyngitis as well as a large area of nonfluctuant induration and swelling posterior to her left mandibular angle (Figure 1). [westjem.com]

• Infectious Mononucleosis

  History The patient was first evaluated at his school clinic where a presumptive diagnosis of infectious mononucleosis (IM) was made and he was treated with oral steroids and NSAIDs. [consultant360.com]

  Pediatric Infect Dis J 1988, 7 (6):410–414. 10.1097/00006454-198806000-00008 View Article Google Scholar Dagan R, Powell KR: Postanginal sepsis following infectious mononucleosis. [intjem.springeropen.com]

  Quantitation of a slide test (Monotest) for infectious mononucleosis J Clin Pathol [online] 1970 Nov, 23(8):700-702 [viewed 25 December 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC476871 20. EILBERT W, SINGLA N. [clinicalsenseapp.com]

  Stenfors LE Bye HM Räisänen S Myklebust R Bacterial penetration into tonsillar surface epithelium during infectious mononucleosis. J Laryngol Otol. 2000; 114: 848-852 28. [thelancet.com]

  mononucleosis (EBV) Patients with peritonsillar abscess have a 20% incidence of mononucleosis [4] Laryngitis Acute Bronchitis Rhinovirus Coronavirus Adenovirus Herpesvirus Influenza virus Coxsackie virus Herpangina Hand-foot-and-mouth disease HIV (Acute [wikem.org]

• Streptococcal Pharyngitis

  Recent evidence (3, 4) suggests that Fusobacterium necrophorum pharyngitis occurs as often as streptococcal pharyngitis in patients aged 15 to 30 years. [annals.org]

  With the introduction of antibiotics in the 1940s and their widespread use for streptococcal pharyngitis, the incidence of Lemierre’s syndrome fell dramatically. [intjem.springeropen.com]

  However its incidence fell dramatically with the introduction of antibiotics for the treatment of streptococcal pharyngitis. Since the advent of antibiotic therapy Lemierre’s syndrome was thought to be the forgotten disease. [ommegaonline.org]

  Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. [clinicalsenseapp.com]

• Fatigue

  A common 1- to 2-week history of fever, sore throat, neck pain, and fatigue was observed in all patients. Patient 1 developed right facial swelling, neck tenderness, trismus, and tonsillar exudate. [ncbi.nlm.nih.gov]

  Unlike many who suffer from the disease, Iniguez was diagnosed with Lemierre's Syndrome, a rare and deadly disease that often goes overlooked by physicians because it presents with such basic symptoms, such as fever, shortness of breath and fatigue. [petaluma360.com]

  A CT chest was also ordered to further evaluate her recent history of “lung infection,” fatigue with ambulation, and rales on pulmonary exam. Care coordination occurred with the radiologist to consider both pneumonia and pulmonary septic emboli. [westjem.com]

• Anemia

  The patient developed severe respiratory failure secondary to primary lung injury and an increased right-to-left shunt, distributive and cardiogenic shock, acute renal and hepatic failure, and anemia. [revespcardiol.org]

  At the moment of release, the blood test showed a normocytic anemia with an hemoglobyn of 10.2, probably related with the septic process, and thrombocytosis of 518.000 platelets. [scielo.isciii.es]

  His past medical history was remarkable for multiple substance abuse, congestive heart failure diagnosed 3 months before admission, irondeficiency anemia, and hyperthyroidism. [journals.lww.com]

  The clinical pictures of lateral sinus thrombosis are well documented: an ill patient with high swinging pyrexia (‘picket fence’ pattern), headache, neck pain and progressive anemia with, less commonly, occipital edema [6]. [otorino-tanzariello.it]

• Sputum

  In addition, P. micros DNA was detected with the polymerase chain reaction (PCR) method in the specimens from the site of culture-negative lesions (i.e. sputum, bronchoalveolar lavage, neck abscess). [doi.org]

  KEYWORDS Lemierre Lemierre’s syndrome Fusobacterium necrophorum suppurative thrombophlebitis Case history A 21-year-old man initially presented with a 1-week history of sore throat, cough productive of brown sputum, odynophagia, fever, rigors and right-sided [rcpjournals.org]

  A throat swab, trans-echocardiogram, abdominal ultrasonoram and several sets of blood and sputum cultures were taken, but we did not find any focus of infection. [kjim.org]

  He took Ibuprofen alternating with acetaminophen for fever, but continued having worsening dyspnea and a cough productive of clear sputum. [oatext.com]

  Blood (anaerobic and aerobic), urine, sputum, and throat cultures were negative as the patient had received antibiotics prior to admission in our hospital. [ijcasereportsandimages.com]

• Nausea

  Gastrointestinal complaints such as abdominal pain, nausea, and vomiting were common (49.5% of cases). An elevated white blood cell count occurred in 75.2% of cases. [ncbi.nlm.nih.gov]

  He presented left otalgia of 5 days’ progression, associated with fever, nausea, and general discomfort. Outpatient treatment with amoxicillin and clavulanic acid was prescribed due to suspicion of acute otitis media. [elsevier.es]

  Persistent sore throat, fever, and general weakness 2 days - 2 weeks after initial symptoms: Lethargy, fevers, lymphadenopathy, painful neck Often abdominal pain, diarrhea, nausea and vomiting May lead to: Pneumonia Septic Arthritis Meningitis Sepsis [wikem.org]

• Dysphagia

  Additional symptoms included sore throat, dysphagia and left otalgia. [westjem.com]

  Thereafter, the infection quickly progresses to cause a pathognomic triad of findings: (1) local symptoms of neck pain, torticollis, trismus, dysphagia or dysarthria ascribable to involvement of the hypoglossal, glossopharyngeal, vagus or accessory nerves [tonsilitisunderstood.blogspot.com]

  If a persistent sore throat, dysphagia or a recent tonsillar or dental infection is reported, practitioners are cautioned to include Lemierre syndrome in the differential diagnosis. [jcda.ca]

  There are local complications such as rupture of the carotid, Horner's syndrome, trapezius muscle paralysis and dysphagia, explained because in the posterior compartment of the parapharyngeal space accompanying the internal jugular vein, the carotid artery [clinmedjournals.org]

  At ENT examination, the patient presented with dysphagia, trismus and temperature 38 °C. [ncbi.nlm.nih.gov]

• Chest Pain

  Case 26-year old obese male presented with 1 week of history of left neck pain, swelling and fever. He had chest pain for 2 days that was severe pressure-like, made worse with laying supine and with deep inspiration, relieved by sitting up. [jacc.org]

  After returning from Thailand, a 23-year-old Japanese man was admitted because of fever, sore throat, neck pain, and chest pain. [ncbi.nlm.nih.gov]

  The initial chest x-ray was unremarkable. His condition did not improve. Two days later he developed left-sided pleuritic chest pain and dyspnea. A repeat chest x-ray revealed right middle lobe infiltrates and a left pleural effusion (Figure 1). [mdmag.com]

  Sign In An 18-year-old man presented with a sore throat, fever, and pleuritic chest pain. Neck CT revealed a thrombus of the right internal jugular vein, and a blood culture grew Fusobacterium necrophorum. Andrew Walkty, M.D. John Embil, M.D. [nejm.org]

• Pericardial Friction Rub

  friction rubs as a sign of pericarditis (rare) * Cranial nerve paralysis and Horner\'s syndrome (both rare) Causes - Lemierre's syndrome Not supplied. [checkorphan.org]

  friction rubs as a sign of pericarditis (rare) Cranial nerve paralysis and Horner's syndrome (both rare) Cause[edit] The bacteria causing the thrombophlebitis are anaerobic bacteria that are typically normal components of the microorganisms that inhabit [en.wikipedia.org]

• Arthritis

  Key words Tonsillectomy Lemierre Septic arthritis This is a preview of subscription content, log in to check access. Copyright information Authors and Affiliations T. F. J. Beldman 1 H. A. Teunisse 1 T. J. Schouten 1 1. [doi.org]

  Ultrastructure of articular cartilage in pyogenic arthritis. Arch Pathol. 1975; 99(1):44-47. [healio.com]

  The previous classical description of severe sepsis with cavitating pneumonia and septic arthritis was not commonly seen in our review. [ncbi.nlm.nih.gov]

• Myalgia

  […] to the editor: A 24-year-old man presented with intermittent fevers and generalized myalgias preceded by sore throat, neck pain, and rhinorrhea several weeks earlier. [aafp.org]

  CASE REPORT An 18-year-old female was admitted to the emergency room with a persistent, week-long fever, a sore throat, rigor and myalgia. [kjim.org]

• Neck Swelling

  Finally, pediatricians, internists, family physicians, and emergency department physicians should know the red flags for adolescent and young adult pharyngitis: worsening symptoms or neck swelling (especially unilateral neck swelling). [ncbi.nlm.nih.gov]

  The 2 major red flags in adolescent and young adult pharyngitis are worsening symptoms or neck swelling. If the patient has bacteremic symptoms, treat either with a combination of penicillin and metronidazole or with clindamycin alone. [annals.org]

  Neck swelling may be evident. Bacteremia and distal infective thromboembolism is common (lungs most commonly affected, however almost any organ may be involved 4 ). [radiopaedia.org]

  1 A Case of Lemierre's Syndrome in Intensive Care Unit. ( 29531456 ) Man M.Y....Lau S.K.P. 2018 2 Lemierre's syndrome: A persistent unusual neck pain and swelling. ( 29796209 ) Vincent Ngu C.Y....Jong Y.H. 2018 3 Lemierre's syndrome: a rare cause of sepsis [malacards.org]

• Kidney Failure

  After infection starts to set in, symptoms worsen and include: High fever Rigors (chills and shivering) Swollen lymph nodes in the neck Joint pain Complications can lead to: Lung abscess Brain abscess Kidney failure Septic shock Acute respiratory distress [clicks.co.za]

  failure Liver failure Abscesses in the spleen Pockets of infection in the muscle and skin Meningitis Brain abscesses Diagnosis Lemierre's syndrome is diagnosed through blood tests that identify the bacteria causing the observed symptoms. [everydayhealth.com]

  failure, liver failure, cerebral edema, organ failure[1] Lemierre's syndrome is infectious thrombophlebitis of the internal jugular vein.[2] It most often develops as a complication of a bacterial sore throat infection in young, otherwise healthy adults [en.wikipedia.org]

  failure and also effects on liver and joints if untreated. [wikidoc.org]

• Headache

  A 76-year-old Japanese male presenting with high fever, headache, and disturbance of consciousness was hospitalized. [ncbi.nlm.nih.gov]

  The latter usually appears with nonspecific symptoms, the most common being frontal headache. 4 The culture was positive for S. viridans. Thrombosis/occlusion of the internal carotid artery is a very rare complication. [elsevier.es]

  Some cases will also present with meningitis, which will typically manifest as neck stiffness, headache and sensitivity of the eyes to light. [en.wikipedia.org]

  We report a case of a 6-year-old boy, who presented with fever and headache with a history of sore throat. [hindawi.com]

  CASE REPORT A 34-year-old housewife presented with a short history of fever, and headache for 20 days; odynophagia, neck pain, right sided facial swelling for 10 days; and hemoptysis for five days. [ijcasereportsandimages.com]

• Stroke

  We present a case of a 10-month-old female infant with Lemierre syndrome complicated by thrombotic strokes and purulent pericarditis. [ncbi.nlm.nih.gov]

  Caplan’s Stroke: a clinical approach. 4th ed., Saunders Elsevier, (2009), Please cite this article as: Gámez-Beltrán P, Vázquez-Sánchez F, López-Veloso M, Casas-Peña E. [elsevier.es]

  Meningitis symptoms include: head swelling seizure or stroke stiff neck irritability or confusion Causes The bacterial infection that causes Lemierre's syndrome may originate inside the throat, ears, or nose. [medicalnewstoday.com]

• Confusion

  CASE HISTORY A 43 year old woman presented with a 2 day history of neck and back pain and a 1 day history of acute confusion with weakness in both legs. [priory.com]

  Lemierre Syndrome (LS) is relatively rare, and its clinical features are potentially confusing. Without proper therapy, LS is associated with significant morbidity and is potentially fatal. [ncbi.nlm.nih.gov]

  Meningitis symptoms include: head swelling seizure or stroke stiff neck irritability or confusion Causes The bacterial infection that causes Lemierre's syndrome may originate inside the throat, ears, or nose. [medicalnewstoday.com]

• Agitation

  On admission she was confused, agitated, febrile and tachycardic. Examination of the chest revealed decreased air entry in her lower lobes bilaterally. [priory.com]

  On admission to hospital she was confused, agitated, febrile and tachycardic. There was decreased air entry to the lung bases bilaterally. [boneandjoint.org.uk]

• Trapezius Muscle Paralysis

  There are local complications such as rupture of the carotid, Horner's syndrome, trapezius muscle paralysis and dysphagia, explained because in the posterior compartment of the parapharyngeal space accompanying the internal jugular vein, the carotid artery [clinmedjournals.org]

A high index of suspicion is needed to consider this diagnosis in the workup of pharyngitis and should be aggressively treated once identified. [ncbi.nlm.nih.gov]

Further imaging workup was then arranged to identify any potential source of the septic emboli but echocardiogram did not reveal any heart valve vegetation. Figure 2. [hkmj.org]

Workup CTA of neck Point of care ultrasound may reveal IJ thrombus Blood Cultures Evaluation Diagnostic criteria: History of oropharynx pain within last 4 wks Evidence of IJV thrombophlebitis/carotid sheath Isolation of F. necrophorum from blood Evidence [wikem.org]

Thrombophilia workup including coagulation studies, Factor V Leiden mutation, prothrombin gene mutation, protein C and S deficiency, antiphospholipid panel, antithrombin III levels, homocysteine level and testing for JAK 2 mutation were all unremarkable [journalofscientificinnovationinmedicine.org]

• Right Pleural Effusion

  A plain chest film showed multifocal nodular infiltration and a right pleural effusion. Based on the radiological view, we first suspected that the diagnosis was either pneumonia or pulmonary tuberculosis. [kjim.org]

  A repeat CXR was obtained on his third day of admission which showed a large right sided pleural effusion (Figure 3). [oatext.com]

  CT chest study revealed numerous cavitating nodular consolidations concerning for septic emboli given the patient’s history, in addition to a small right pleural effusion (Image 2). [westjem.com]

  A follow-up CT of the neck and chest showed no significant change in the IJV thrombus and a slight decrease in the right pleural effusion. [journals.lww.com]

• Left Pleural Effusion

  Two days later he developed left-sided pleuritic chest pain and dyspnea. A repeat chest x-ray revealed right middle lobe infiltrates and a left pleural effusion (Figure 1). A thoracentesis demonstrated an exudative effusion. [mdmag.com]

• Neutrophilia

  The patient had a neutrophilia and a markedly elevated CRP of 396.5. [priory.com]

  The blood test showed an increase in leukocytes with neutrophilia and Reactive C Protein of 19 mgr/dL (normal range 0-0.5 mg/dl). [clinmedjournals.org]

  Laboratory tests found leukocytosis (22,000) and neutrophilia (88.3%), with the remainder of the parameters being normal. [elsevier.es]

  WBC was 18.2 × 109/L, with neutrophilia (14.94 × 109/L). Labs were otherwise unimpressive including urea and electrolytes panel, urine analysis and culture. [hindawi.com]

  Peripheral blood smear revealed normocytic normochromic anaemia and neutrophilia with toxic granulations. Ultrasonography of neck swelling showed a focal heterogenous area of 3.5cm diameter with ill-defined borders in the intramuscular plane. [ispub.com]

• Candida

  […] melaninogenicus, Bacteroides distasonis, Bacteroides uniformis, Peptostreptococcus, Group B and C Streptococcus, Streptococcus oralis, Staphylococcus epidermidis, Enterococcus sp., Proteus mirabilis, Eubacterium sp., Eikenella corrodens, lactobacilli, and Candida [ispub.com]

One week after discharge, he had fully recovered, and treatment was changed to oral metronidazole monotherapy for a further three weeks and a total of three months’ anticoagulation treatment. [cmaj.ca]

Treatment involves aggressive and prolonged antibiotic therapy, sometimes in combination with surgical treatment to drain the collection of pus depending on its location. [ommegaonline.org]

Anticoagulation treatment with a vitamin K antagonist was prolonged for 6 months. [signavitae.com]

She was followed up in Ear, Nose and Throat (ENT) outpatient clinics 2 months later but did not require any further treatment. [omicsonline.org]

Even without internal jugular thrombosis, the same mechanism of disease exists, and therefore, the same morbidity, prognosis, and treatments are applicable, hence the suitable term incomplete Lemierre syndrome. [ncbi.nlm.nih.gov]

If unrecognised and untreated, systemic dissemination can occur with a dismal prognosis; studies from the modern era still report mortality rates as high as 18% 8. [radiopaedia.org]

High-dose parenteral antibiotics Anticoagulation Ligation or resection of the internal jugular vein on occasion Complications Pulmonary septic emboli Empyema Lung abscess Septic arthritis, osteomyelitis or hepatic abscesses through a patent foramen ovale Prognosis [learningradiology.com]

This can result in treatment delays.[1][2][3] Etiology Lemierre syndrome originates as a complication of bacterial throat infections. [statpearls.com]

In 81% of the cases, the Fusobacterium necrophorum is the most frequent etiologic agent. Fever is the most common symptom, but it can depending on the primary infection, tonsillitis, mastoiditis or odontogenic infection. [ncbi.nlm.nih.gov]

Fusobacterium necrophorum is the usual etiologic agent. The disease progresses in several steps. The first stage is the primary infection, which is usually a pharyngitis (87.1% of cases). [doi.org]

Further epidemiologic research is needed on both F. necrophorum pharyngitis (especially clinical presentation) and the Lemierre syndrome. Clinicians need reliable diagnostic techniques for F. necrophorum pharyngitis. [ncbi.nlm.nih.gov]

Lemierre’s syndrome and other disseminated Fusobacterium necrophorum infections in Denmark: a prospective epidemiological and clinical survey. [thrombosisresearch.com]

Pediatrics 112:e380 Article Google Scholar Hagelskjaer Kristensen L, Prag J (2008) Lemierre’s syndrome and other disseminated Fusobacterium necrophorum infections in Denmark: a prospective epidemiological and clinical survey. [link.springer.com]

Rev Infect Dis. 1989; 11: 319-324 Hagelskjaer LH Prag J Malczynski J Kristensen JH Incidence and clinical epidemiology of necrobacillosis, including Lemierre's syndrome, in Denmark 1990-1995. [mayoclinicproceedings.org]

Incidence and clinical epidemiology of necrobacillosis, including Lemierre's syndrome, in Denmark 1990-1995. Eur J Clin Microbiol Infect Dis 1998;17:561-5. [Crossref] [PubMed] Karkos PD, Asrani S, Karkos CD, et al. [jeccm.amegroups.com]

Considering the details of imaging and bacterial examination is very useful for understanding the pathophysiology and determining appropriate treatment in Lemierre’s syndrome pathophysiology and determining appropriate treatment in Lemierre’s syndrome [advancedotology.org]

The underlying pathophysiology and treatment options are discussed here. With rapid increase in reporting of Lemierre syndrome, this case deserves particular attention from clinicians. [ncbi.nlm.nih.gov]

The pathophysiology, natural history, diagnostic methods for internal jugular vein thrombosis, and management are discussed. [doi.org]

Genomic study of several patients with Lemierre's syndrome may reveal its pathophysiology. [bmcinfectdis.biomedcentral.com]

Early diagnosis and treatment of anaerobic pharyngitis is critical to prevent Lemierre Syndrome. Respiratory precautions should be recommended to medical staff caring for patients with suspected Lemierre Syndrome to prevent nosocomial transmission. [ncbi.nlm.nih.gov]

Prevention of suppuration can be achieved by early and proper therapy of odontogenic infections. A poor response in the treatment of Lemierre syndrome may require the need for anticoagulation, rather than for a change in antibiotics. [tonsilitisunderstood.blogspot.com]

This case shows the importance of making the correct diagnosis and subsequentappropriate treatment to prevent the serious morbidity and mortality associated with Lemierre’s syndrome. [ommegaonline.org]