title: Is this a variant of Lemierre's syndrome?
abstract: Lemierre's syndrome is an oropharyngeal infection leading to secondary septic thrombophlebitis of the internal jugular vein (IJV). It is classically anaerobic in origin and Fusobacterium necrophorum is the commonest pathogen. We report an unusual variant of this condition in a 68-year-man with uncontrolled diabetes mellitus who presented with extensive cellulitis of the left neck. No primary oropharyngeal sepsis was detected. Neck radiographs revealed soft tissue gas and computed tomography confirmed neck space infection with gas formation and complete thrombosis of the left IJV. Klebsiella pneumoniae was isolated from the fluid, tissue and blood samples. Repeated debridement was required until complete healing. Computed tomography of the neck at six months showed resolution of infection, although the vein remained thrombosed. Although the radiological features resemble Lemierre's syndrome, this case differs from it in the absence of oropharyngeal sepsis and presence of background diabetes mellitus. The isolation of Klebsiella pneumoniae as a cause has not been previously described.
authors.affiliation: Department of Surgery, Alexandra Hospital, Singapore. reyazm@yahoo.com
authors.forename: R M
authors.initials: RM
authors.lastname: Singaporewalla
authors.forename: M J
authors.initials: MJ
authors.lastname: Clarke
authors.forename: P U
authors.initials: PU
authors.lastname: Krishnan
authors.forename: D E L
authors.initials: DE
authors.lastname: Tan
mesh_terms: D000368:Aged; D002481:Cellulitis / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D048909:Diabetes Complications / Q000382:microbiology*; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D007710:Klebsiella Infections / Q000097:blood / Q000150:complications*; D007711:Klebsiella pneumoniae / Q000302:isolation & purification / Q000472:pathogenicity; D008297:Male; D011859:Radiography; D013577:Syndrome; D013924:Thrombophlebitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000382:microbiology