title: Lemierre's syndrome secondary to community-acquired methicillin-resistant Staphylococcus aureus infection presenting with cardiac tamponade, a rare disease with a life-threatening presentation: a case report.
abstract: BACKGROUND
  Lemierre's syndrome is a rare condition characterized by thrombophlebitis of internal jugular vein, septicemia and septic metastatic infection of different organs. It is preceded by an oropharyngeal infection by anaerobic organisms. Community-acquired methicillin-resistant Staphylococcus aureus is now emerging as a causative organism in Lemierre's syndrome. Clinical manifestations vary depending on the organ system affected by the infection. Although rare, patients may present with life-threatening conditions such as cardiac tamponade.
  
  
  METHODS
  We report the first case, to our knowledge, of Lemierre's syndrome presenting with cardiac tamponade secondary to community-acquired methicillin-resistant S. aureus in a previously well 45-year-old Sri Lankan lady. Fever, sore throat and left-sided neck pain complicated with facial and left upper limb swelling were followed by severe shortness of breath for 24 h. There was tachycardia with pulsus paradoxus, low blood pressure and soft heart sounds. Pericardial effusion with cardiac tamponade was detected on echocardiogram and methicillin-resistant S. aureus species were isolated in both blood and pericardial fluid cultures. Venous duplex of neck veins and computed tomography scan of the neck showed thrombosis of left-sided internal jugular, external jugular, subclavian and axillary veins. Diagnosis of Lemierre's syndrome was made, and patient had a satisfactory recovery following emergency pericardiocentesis and a prolonged course of antibiotics.
  
  
  CONCLUSIONS
  Although uncommon, Lemierre's syndrome is a life-threatening condition. Patients may present with cardiac tamponade secondary to purulent pericarditis in Lemierre's syndrome, where emergency pericardiocentesis is lifesaving. Community-acquired methicillin-resistant S. aureus is emerging as a causative agent in Lemierre's syndrome, and awareness is required amongst physicians for prompt diagnosis and appropriate empirical treatment to prevent mortality and morbidity associated with the disease.
authors: Department of Medicine, Teaching Hospital, Kandy 20000, Sri Lanka.
authors: Sonali Sihindi Chapa
authors: SS
authors: Gunatilake
authors: Department of Microbiology, Teaching Hospital, Kandy 20000, Sri Lanka.
authors: Lakmini Gunarathna
authors: LG
authors: Yapa
authors: Department of Medicine, Teaching Hospital, Kandy 20000, Sri Lanka.
authors: Malinga
authors: M
authors: Gallala
authors: Department of Medicine, Teaching Hospital, Kandy 20000, Sri Lanka.
authors: Rohitha
authors: R
authors: Gamlath
authors: Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 00300, Sri Lanka.
authors: Chaturaka
authors: C
authors: Rodrigo
authors: Department of Medicine, Teaching Hospital, Kandy 20000, Sri Lanka.
authors: Harith
authors: H
authors: Wimalaratna
keywords: Cardiac tamponade; Community acquired methicillin resistant Staphylococcus aureus; Fusobacterium necrophorum; Lemierre’s syndrome; Pericardiocentesis; Thrombophlebitis
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