A 21-year-old man with fever and abdominal pain after recent peritonsillar abscess drainage.
Lemierre syndrome an extremely rare and unreported disease typically results from oropharyngeal infection and/or local tissue trauma with invasion of the parapharyngeal soft tissue with bacteria. Once local tissue invasion occurs, internal jugular vein septic thrombophlebitis with or without metastatic complications may occur. The etiology of Lemierre syndrome is generally Fusobacterium necrophorum, reported to be present in approximately 80% of the cases. The outcome of Lemierre syndrome in the preantibiotic era was nearly always fatal. The outcome today with the appropriate antibiotic coverage is quite good. The management of a patient with suspected Lemierre syndrome should be aggressive and comprehensive. Blood cultures as well as cultures from infection sites should be obtained. Computed tomography, magnetic resonance imaging, and ultrasound are all appropriate modalities to detect the presence of internal jugular vein thrombophlebitis. Treatment of Lemierre syndrome consists of prolonged antibiotic therapy (4 to 6 weeks) with appropriate anaerobic coverage. Typical antibiotics include penicillins, metronidazole, or clindamycin. Surgical drainage of metastatic abscesses is often needed ensure resolution of this disease process. Persistent sore throat syndrome caused by F necrophorum has been reported in the literature and the General Practitioners should be aware of this entity because they may see this in their practice.
David
Henry
H
Department of Emergency Medicine, University of Missouri, Columbia, MO 65212, USA. davidhe@health.missouri.edu
D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D004322:Drainage / Q000009:adverse effects*; D005334:Fever / Q000209:etiology*; D005674:Fusobacterium Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D016967:Fusobacterium nucleatum; D006801:Humans; D007601:Jugular Veins; D008100:Liver Abscess / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D000039:Peritonsillar Abscess / Q000150:complications* / Q000628:therapy; D013577:Syndrome; D013924:Thrombophlebitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D014057:Tomography, X-Ray Computed