title: [A case of corticosteroid-responsive Lemierre syndrome with clivus osteomyelitis and a mass in the cavernous sinus-suprasellar region].
abstract: Lemierre syndrome is a clinical syndrome that presents with internal jugular thrombophlebitis, septicemia and systemic abscess formations. In general, the condition is preceded by oropharyngeal infections. We report a case of a 73-year-old man with Lemierre syndrome, clivus osteomyelitis and a steroid-responsive mass in the cavernous sinus-suprasellar region. He complained of fever, occipital pain, diplopia and right ptosis. Administration of oral steroids ameliorated the ophthalmic symptoms for a period before he was admitted to our hospital. After admission, the severity of his headache advanced, and his ophthalmic symptoms progressed bilaterally. Brain magnetic resonance imaging showed contrast enhancement of the clivus and revealed a mass lesion contrast-enhancement effect in the cavernous sinus-suprasellar region. Fusobacterium nucleatum was detected by blood culture, and computed tomography revealed multiple bacterial emboli in both lung fields and thrombosis of the left internal jugular vein; thus, he was diagnosed with Lemierre syndrome. After venous administration of antibiotics, his fever and headache markedly improved, but the ophthalmic symptoms did not. We prescribed an oral steroid because the cavernous sinus-suprasellar lesion was probably an inflammatory granuloma caused by a para-infectious mechanism rather than by infection. After the series of treatments, his ophthalmic symptoms improved, and the cavernous sinus-suprasellar region mass lesion decreased. He was eventually discharged in a fully ambulatory state and had no ophthalmic difficulties. We thought that the osteomyelitis of clivus was caused by Lemierre syndrome and its inflammatory processes formed the granuloma in the cavernous sinus-suprasellar region. This was a case of Lemierre syndrome with a rare combination of clivus osteomyelitis and a steroid-responsive tumour in the cavernous sinus-suprasellar region that was successfully treated.
authors.affiliation: Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University.
authors.forename: Shotaro
authors.initials: S
authors.lastname: Takahashi
authors.forename: Satoru
authors.initials: S
authors.lastname: Ito
authors.forename: Shugo
authors.initials: S
authors.lastname: Tagashira
authors.forename: Kenichi
authors.initials: K
authors.lastname: Yasui
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Kenji
authors.initials: K
authors.lastname: Nakashima
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000667:Ampicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002426:Cavernous Sinus; D003388:Cranial Fossa, Posterior; D004359:Drug Therapy, Combination; D016967:Fusobacterium nucleatum / Q000302:isolation & purification / Q000472:pathogenicity; D005938:Glucocorticoids / Q000008:administration & dosage*; D006099:Granuloma / Q000209:etiology*; D006801:Humans; D007262:Infusions, Intravenous; D057831:Lemierre Syndrome / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D008279:Magnetic Resonance Imaging; D008297:Male; D010019:Osteomyelitis / Q000209:etiology*; D011239:Prednisolone / Q000008:administration & dosage*; D013407:Sulbactam / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000209:etiology*
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; C035444:sultamicillin; D000667:Ampicillin; D011239:Prednisolone; D013407:Sulbactam