title: Liver abscessation and multiple septic pulmonary emboli associated with Lemierre's syndrome: a case report.
abstract: BACKGROUND
  In Lemierre's syndrome, patients first exhibit pharyngitis and peritonsillar abscessation, followed by the development of anaerobic bacterial (usually Fusobacterium necrophorum) septicemia and metastatic infections throughout the body. However, these infections rarely affect the liver. We describe a case of Lemierre's syndrome, in which the first disease manifestation was liver abscess, for drawing attention of emergency physicians to this rare but fatal disease.
  
  
  METHODS
  A 28-year-old Asian ethnicity Filipino male, who was previously healthy, entered the emergency department presenting with fever and pharyngeal pain that had persisted for 5 days. Contrast-enhanced abdominal computed tomography revealed a 3-cm area of low density in segment 6 of the liver, consistent with an abscess. Chest computed tomography also revealed that multiple nodes in both lungs were enlarged, and septic emboli were suspected. The patient was hospitalized and antibiotic treatment was initiated. On hospital day 6, blood culture results confirmed Fusobacterium necrophorum septicemia. The patient was diagnosed with Lemierre's syndrome, as pharyngitis developed into bacteremia associated with hepatic and pulmonary lesions. The patient's condition improved with antibiotics and he was discharged following three weeks of treatment in the hospital.
  
  
  CONCLUSIONS
  With the widespread use of antibiotics, Lemierre's syndrome is rarely encountered anymore, but it can be fatal if not properly diagnosed. It is a crucial differential diagnosis in young patients exhibiting septicemia or multiple metastatic infection of unknown origin.
authors.affiliation: Department of Emergency and Critical Care Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan. yuichitakano1028@yahoo.co.jp.|Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan. yuichitakano1028@yahoo.co.jp.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Takano
authors.affiliation: Department of Emergency and Critical Care Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan. ennyfukuda511@yahoo.co.jp.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Fukuda
authors.affiliation: Department of Emergency and Critical Care Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan. rinomizuki@yahoo.co.jp.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Takayasu
authors.affiliation: Department of Emergency and Critical Care Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan. samurai.baseball.18@gmail.com.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Shinmura
authors.affiliation: Department of Emergency and Critical Care Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan. unfiny@gmail.com.
authors.forename: Go
authors.initials: G
authors.lastname: Koizumi
authors.affiliation: Department of Emergency and Critical Care Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan. sst004@yahoo.co.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sasai
authors.affiliation: Department of Emergency and Critical Care Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan. ynaga1147@hotmail.co.jp.
authors.forename: Yoshikuni
authors.initials: Y
authors.lastname: Nagayama
authors.affiliation: Department of Emergency and Critical Care Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan. mkawamo@mysrv.org.
authors.forename: Michiari
authors.initials: M
authors.lastname: Kawamo
authors.affiliation: Department of Emergency and Critical Care Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan. shapedbytomo@hotmail.co.jp.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Yasuda
authors.affiliation: Department of Emergency and Critical Care Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan. zznabe@gmail.com.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Emergency and Critical Care Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan. fujigaoka-hp-sasaki@docomo.ne.jp.
authors.forename: Jun
authors.initials: J
authors.lastname: Sasaki
authors.affiliation: Department of Emergency and Critical Care Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan. munetaka@med.showa-u.ac.jp.
authors.forename: Munetaka
authors.initials: M
authors.lastname: Hayashi
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan. a-little-prayer@hotmail.co.jp.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Yamamura
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan. naomaruoka@gmail.com.
authors.forename: Naotaka
authors.initials: N
authors.lastname: Maruoka
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan. masatsugu.nagahama@gmail.com.
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Nagahama
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan. htakaha@med.showa-u.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D006801:Humans; D057831:Lemierre Syndrome / Q000150:complications* / Q000000981:diagnostic imaging; D008100:Liver Abscess / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D011655:Pulmonary Embolism / Q000150:complications* / Q000000981:diagnostic imaging; D018805:Sepsis / Q000150:complications* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography