Endoscopic sphenoid sinus drainage in Lemierre syndrome.
Lemierre syndrome is a rare condition arising from an invasive oropharyngeal infection, which leads to septic thrombophlebitis of the internal jugular vein and multi-organ septic embolization. Intracranial complications are rare but serious, including subdural empyema, cavernous sinus thrombosis, and internal carotid artery aneurysms. We report a patient with Lemierre syndrome with multiple intracranial complications despite aggressive antimicrobial therapy. The patient eventually required transsphenoidal endoscopic drainage of the sphenoid sinus to help eradicate the infectious source. We postulate that in patients with Lemierre syndrome with evidence of infection in the paranasal sinuses, endoscopic sinus drainage can be an adjunct to antimicrobial therapy in achieving infection control.
Interdepartmental Division of Critical Care and Department of Medicine, University of Toronto, 399 Bathurst Street, 2 McLaughlin 411P, Toronto, ON Canada M5T 2S8; Department of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: eyal.golan@uhn.ca.
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E
Golan
Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Wong
Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
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H
Alahmadi
Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
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RF
Agid
Department of Medicine, University of Toronto, Toronto, ON, Canada.
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A
Morris
Department of Medicine, University of Toronto, Toronto, ON, Canada.
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A
Sharkawy
Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
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Zadeh
D000328:Adult; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology; D002533:Cerebral Angiography; D004322:Drainage / Q000379:methods; D004724:Endoscopy / Q000379:methods; D005500:Follow-Up Studies; D006257:Head / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D057831:Lemierre Syndrome / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D013101:Sphenoid Sinus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Cavernous sinus thrombosis; Fusobacterium necrophorum; Intracranial mycotic aneurysm; Lemierre syndrome; Subdural empyema; Thrombophlebitis