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]

  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]

  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]

• 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. [link.springer.com]

  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]

  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]

• Cerebral Palsy

  In the other side, and despite an aggressive therapy, an 18-month-old infant developed cerebral palsy. [ncbi.nlm.nih.gov]

• Intravenous Administration

  Prolonged intravenous administration of antimicrobial agents known to have a good antianaerobic coverage, along with drainage of purulent collections, will usually be successful in the overwhelming majority of patients. [ncbi.nlm.nih.gov]

• 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]

  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]

• Tonsillar Exudate

  Patient 1 developed right facial swelling, neck tenderness, trismus, and tonsillar exudate. Patient 2 displayed right tonsillar erythema and enlargement with right neck tenderness. [ncbi.nlm.nih.gov]

  His throat appeared inflamed, but there was no tonsillar exudate. His cervical lymph nodes were tender and enlarged. There were no rashes or peripheral stigmata of infective endocarditis. Cardiorespiratory and abdominal examination were normal. [cmaj.ca]

• Hepatosplenomegaly

  Abdominal examination was significant for hepatosplenomegaly. There was generalized tenderness to palpation but no peritoneal signs or masses were appreciated. Pulmonary, neurologic, and musculoskeletal examination were normal. [consultant360.com]

• 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

  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]

• 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

  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]

  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]

• Facial Swelling

  Patient 1 developed right facial swelling, neck tenderness, trismus, and tonsillar exudate. Patient 2 displayed right tonsillar erythema and enlargement with right neck tenderness. [ncbi.nlm.nih.gov]

  General examination showed right sided facial swelling and tenderness along the right sided sternocleidomastoid. Oral examination revealed inflammation of right tonsillar fossa. [ijcasereportsandimages.com]

• 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]

  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]

  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]

  His headache was terrible, almost as bad as it had been in the hospital, where it had brought the man to tears — something his wife had never seen before. [well.blogs.nytimes.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]

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]

• Cavitary Lesion

  […] for further characterisation of these lesions and confirmed multiple cavitary lesions of variable sizes involving all the lung lobes ( Fig 2 ). [hkmj.org]

  In the lungs, the bacteria cause abscesses, nodulary and cavitary lesions. Pleural effusion is often present. [en.wikipedia.org]

  Cavitary lesions are not uncommon. Large joints such as the shoulders, hips, and knees can also be affected. Presentations can vary from arthralgias to septic arthritis and even osteomyelitis. [antimicrobe.org]

  When lungs are involved, chest x-rays frequently reveal bilateral nodular infiltrates, cavitary lesions, and pleural effusions. 3 A contrast-enhanced CT of the neck is preferred to diagnose internal jugular vein thrombophlebitis, although an MRI or ultrasonography [consultant360.com]

  Lung lesions typically begin as multiple, usually nodular infiltrates that progress rapidly to cavitary lesions and are frequently accompanied by pleural effusions [ 23 ]. [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]

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

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]

Etiology: This syndrome is caused by extension of infection into the carotid space. source of infection could be any of the deep neck space infections. Clinical features: 1. [sites.google.com]

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]

Finally we had an epidemiologic study which defined the extent of this disease. I have extrapolated the Danish data to the United States. [medrants.com]

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]

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]

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]

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 [lifeinthefastlane.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]