Clival osteomyelitis and hypoglossal nerve palsy--rare complications of Lemierre's syndrome.
An increasingly reported entity, Lemierre's syndrome classically presents with a recent oropharyngeal infection, internal jugular vein thrombosis and the presence of anaerobic organisms such as Fusobacterium necrophorum. The authors report a normally fit and well 17-year-old boy who presented with severe sepsis following a 5-day history of a sore throat, myalgia and neck stiffness requiring intensive care admission. Blood cultures grew F. necrophorum and radiological investigations demonstrated left internal jugular vein, cavernous sinus and sigmoid sinus thrombus, left vertebral artery dissection and thrombus within the left internal carotid artery. Imaging also revealed two areas of acute ischaemia in the brain, consistent with septic emboli, skull base (clival) osteomyelitis and an extensive epidural abscess. The patient improved on meropenem and metronidazole and was warfarinised for his cavernous sinus thrombosis. He has an on-going left-sided hypoglossal (XIIth) nerve palsy.
Department of Medicine, Royal Devon and Exeter Hospital, Exeter, Devon, UK.
Jingzhou
J
He
Department of Medicine, Leicester Royal Infirmary, Leicester, UK.
Jonathan Chun Leuk
JC
Lam
Department of Radiology, Royal Devon and Exeter Hospital, Exeter, Devon, UK.
Tarig
T
Adlan
D000293:Adolescent; D000890:Anti-Infective Agents / Q000008:administration & dosage; D000925:Anticoagulants / Q000008:administration & dosage; D003388:Cranial Fossa, Posterior / Q000473:pathology; D005334:Fever / Q000209:etiology; D005674:Fusobacterium Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D005675:Fusobacterium necrophorum / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D020437:Hypoglossal Nerve Diseases / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D007601:Jugular Veins / Q000473:pathology; D057831:Lemierre Syndrome / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D000077731:Meropenem; D008795:Metronidazole / Q000008:administration & dosage; D010019:Osteomyelitis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D010612:Pharyngitis / Q000209:etiology; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D013845:Thienamycins / Q000008:administration & dosage; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage
D000890:Anti-Infective Agents; D000925:Anticoagulants; D013845:Thienamycins; D008795:Metronidazole; D014859:Warfarin; D000077731:Meropenem