title: Lemierre syndrome complicating multiple brain abscesses caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae cured by fosfomycin and meropenem combination therapy.
abstract: A woman aged 56 years of age had a community-acquired left neck abscess and internal jugular vein thrombosis with septicemia due to extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae. Even though she was treated with intravenous meropenem, the bacteremia persisted. She was complicated with multiple brain abscesses, seizure, and leucopenia. After a combination of intravenous fosfomycin and meropenem, her clinical condition became stable. Combination treatment was continued for 2 months and she recovered. In individual cases of Lemierre syndrome with brain abscess caused by ESBL-producing Enterobacteriaceae, fosfomycin combination therapy may be the alternative choice.
authors.affiliation: Division of Infectious Disease, Department of Medicine, Wan Fang Hospital, Taipei Medical University, Taiwan.
authors.forename: Wen-Sen
authors.initials: WS
authors.lastname: Lee
authors.forename: Fu-Der
authors.initials: FD
authors.lastname: Wang
authors.forename: Ying-Hua
authors.initials: YH
authors.lastname: Shieh
authors.forename: Sing-On
authors.initials: SO
authors.lastname: Teng
authors.forename: Tsong-Yih
authors.initials: TY
authors.lastname: Ou
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001921:Brain / Q000000981:diagnostic imaging; D001922:Brain Abscess / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005578:Fosfomycin / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007710:Klebsiella Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D057831:Lemierre Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D000077731:Meropenem; D008875:Middle Aged; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D013845:Thienamycins / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D005578:Fosfomycin; D001618:beta-Lactamases; D000077731:Meropenem