title: Septic internal jugular vein thrombosis caused by Fusobacterium necrophorum and mediated by a broken needle.
abstract: The injection of drugs into the neck is unusual and thrombosis of the internal jugular vein can be a rare clinical presentation with a high risk for severe complications. We report a case of a 31-year-old male intravenous drug user presenting with fever, shortness of breath and right neck oedema. Laboratory studies revealed elevated inflammation parameters. X-ray imaging revealed a broken syringe needle inside the soft tissues of the neck. Computed tomography (CT) scans of the thorax and brain were unremarkable, while cervical CT showed a fully thrombosed, right internal jugular vein. Intravenous antibiotics were initiated, and modified after identification of an anaerobic Gram-negative oropharynx-derived pathogen (Fusobacterium necrophorum). The patient was discharged after resolution of symptoms under treatment. Septic internal jugular vein thrombosis should always be included in the differential diagnosis of local neck inflammation and systemic sepsis in intravenous drug users. Prompt and aggressive antibiotic treatment is vital, whereas the role of anticoagulation therapy is not definitely known.
authors.affiliation: From the Department of Surgery, General Hospital of Chalkis , Chalkis , Greece.
authors.forename: George
authors.initials: G
authors.lastname: Galyfos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Palogos
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kavouras
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D055030:Drug Users; D005334:Fever; D005674:Fusobacterium Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology; D005675:Fusobacterium necrophorum / Q000302:isolation & purification*; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000382:microbiology*; D008297:Male; D009333:Neck / Q000000981:diagnostic imaging; D009339:Needles; D009960:Oropharynx / Q000382:microbiology; D018805:Sepsis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Fusobacterium necrophorum; Intravenous drug use; Lemierre syndrome; anticoagulation; septic thrombophlebitis