We present a case of invasive Fusobacterium infection that meets all criteria for Lemierre syndrome except lacking internal jugular thrombosis. [ncbi.nlm.nih.gov]

• 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]

  Postanginal sepsis following infectious mononucleosis. Arch Intern Med. 1987 Sep; 147 (9):1581–1583. [ PubMed ] [ Google Scholar ] Busch N, Mertens PR, Schönfelder T, Nguyen H, Marschall HU, Kierdorf H, Haase G, Urhahn R, Sieberth HG, Matern S. [ncbi.nlm.nih.gov]

  R. ( 1987 ) Postanginal sepsis following infectious mononucleosis. Archives of Internal Medicine 147 : 1581 – 1583. Duerden, B. I. ( 1990 ) The bacteroidacea: bacteroides, fusobacteria and leptotrichia. [cambridge.org]

  Several cases of Lemierre's syndrome preceded by infectious mononucleosis have been reported, 11 12 so that some authors have suggested the possible role of primary viral throat infection as a risk factor for the syndrome. 3 Enhancement of toxins from [pmj.bmj.com]

• Streptococcal Pharyngitis

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

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

  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]

• 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]

  Breathlessness really sucks, I had chronic fatigue before so was not exactly in the pinkest of health but at least I could walk upstairs without sounding like an asthmatic Gerbil ! [city-data.com]

• Nausea

  We report a case of a previously healthy 33-year-old male who presented to his primary care physician with nausea, vomiting, diarrhoea and fever. [ncbi.nlm.nih.gov]

  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. [doi.org]

  Often there is abdominal pain, diarrhea, nausea and vomiting during this phase. These signs and symptoms usually occur several days to 2 weeks after the initial symptoms. [en.wikipedia.org]

  Abdominal pain with nausea, vomiting, and diarrhea can be seen. End-organ damage can also be detected, including decreased urine output, as well as spleen and liver enlargement. Occasionally, meningitis will also occur. [emdocs.net]

• 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) The bacteria causing the thrombophlebitis are anaerobic bacteria that are typically normal components of the microorganisms that inhabit the mouth [en.wikipedia.org]

• Joint Effusion

  He developed left-sided complicated otitis media with retroauricular fluid collection, mastoiditis, and temporomandibular joint effusion. The clinical picture was complicated by a left internal jugular vein and left lateral sinus thrombosis. [ncbi.nlm.nih.gov]

• Oligoarthritis

  Postma, A 25-year-old male with oligoarthritis as the first sign of Lemierre’s syndrome, Infection, 10.1007/s15010-010-0071-7, 39, 1, (87-89), (2011). [doi.org]

• Chemosis

  A 54-year-old woman presented with fever, spasmodic torticollis, ptosis, and chemosis in her left eye. [ncbi.nlm.nih.gov]

• Blepharoptosis

  A 51-year-old woman was hospitalized with a high fever, occipital pain, blepharoptosis, and trismus. [ncbi.nlm.nih.gov]

  Megu Yamaguchi, Hitoshi Nishizawa, Taku Yasumoto, Takekazu Kimura, Yasuo Takeuchi, Akinori Takeshita, Toshiyuki Takase, Hiroaki Fujimoto, Misa Nakano and Megumu Fukunaga, Lemierre Syndrome with Blepharoptosis, Internal Medicine, 10.2169/internalmedicine [doi.org]

• Visual Impairment

  An 86-year-old patient was hospitalized for fever and left acute orbital syndrome (red eye with moderate visual impairment, chemosis, ophthalmoplegia without proptosis, or any fundus involvement). [ncbi.nlm.nih.gov]

• Neck Swelling

  A 10-year-old boy is reported who had a five-day history of ear infection, with the development of fever, drowsiness and ipsilateral neck swelling. Unexpected cardiac arrest occurred soon after medical assessment. [ncbi.nlm.nih.gov]

  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]

  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]

• Cellulitis of the Face

  We report the case of a 22-year-old woman hospitalized initially for cellulitis of the face. [ncbi.nlm.nih.gov]

• 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]

• Headache

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

  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]

  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]

  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]

• Polyneuropathy

  Each of these had varied presentations and neurologic complications-one developed 9th to 12th cranial nerve palsies and Horner syndrome, which have not been described in previous literature, and the other developed polyneuropathy and a frontal lobe infarct [ncbi.nlm.nih.gov]

  Each of these had varied presentations and neurologic complications—one developed 9th to 12th cranial nerve palsies and Horner syndrome, which have not been described in previous literature, and the other developed polyneuropathy and a frontal lobe infarct [doi.org]

• Generalized Tonic-Clonic Seizure

  Her hospital course was complicated by a middle cerebral artery distribution infarction and subsequent hemorrhagic conversion with generalized tonic clonic seizures managed by levetiracetam. [ncbi.nlm.nih.gov]

• Cranial Neuropathy

  Abstract Lemierre syndrome is usually caused by Fusobacterium necrophorum, but we recently encountered a case due to methicillin-resistant Staphylococcus aureus and complicated by sigmoid sinus thrombosis and cranial neuropathies. [ncbi.nlm.nih.gov]

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]

After initial workup and physical examination, the ED discharged him with same diagnosis of IM. [consultant360.com]

Workup for the presence of a hypercoagulable state was negative, and the patient was anticoagulated with enoxaparin. He was discharged home to complete a 6-week course of antibiotics and anticoagulation. [link.springer.com]

• Pericardial Effusion

  Ten days into her hospital stay, she developed pericardial tamponade, and cardiac surgery performed a pericardial window for loculated, purulent pericardial effusion. [ncbi.nlm.nih.gov]

Treatment with broad-spectrum antibiotics is the primary choice of treatment of Lemierre syndrome. Surgery is indicated in case of abscess formation. [ncbi.nlm.nih.gov]

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]

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]

PubMed Google Scholar Hagelskjaer LH, Prag J, et al: Incidence and clinical epidemiology of necrobacillosis in Denmark 1990-1995. Eur J Clin Microbiol Infect Dis. 1998, 17: 561-565. 10.1007/BF01708619. [casesjournal.biomedcentral.com]

Incidence and clinical epidemiology of necrobacillosis, including Lemierre's syndrome, in Denmark 1990–1995. Eur J Clin Microbiol Infect Dis. 1998;17:561–5. ... 2. Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ. [aafp.org]

HagelskjaerKristensen L, Prag J.Lemierre’s syndrome and other disseminated Fusobacteriumnecrophorum infections in Denmark: a prospective epidemiological and clinical survey.Eur JClinMicrobiol Infect Dis. 2008; 27: 779–89. [nzma.org.nz]

Epidemiology : Although extremely rare now, Lemierre’s syndrome was common prior to the age of penicillins. [emdocs.net]

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]

S.aureus) PATHOPHYSIOLOGY Primary infection is followed by local invasion of the lateral pharyngeal space then septic thrombophlebitis of the IJ vein primary source of infection is commonly the palatine tonsils and peritonsillar tissue other sources include [litfl.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]