title: Gastrointestinal variant of Lemierre's syndrome complicating ruptured appendicitis.
abstract: Fusobacterium necrophorum is a non-spore-forming, obligate anaerobic, filamentous, gramnegative bacillus that frequently colonizes the human oral cavity, respiratory tract, and gastrointestinal tract. Fusobacterium species have rarely been implicated in cases of gastrointestinal variant of Lemierre's syndrome. We describe a case of F. necrophorum bacteremia associated with suppurative porto-mesenteric vein thrombosis (PVT) following acute ruptured appendicitis. In addition, we list the documented twelve cases of Fusobacterium pylephlebitis. Recanalization of the porto-mesenteric veins and relief of the extrahepatic portal hypertension were achieved with early empiric antibiotic and local thrombolytic therapy. Our patient's case underscores the importance of recognizing Fusobacterium bacteremia as a possible cause of suppurative PVT after disruption of the gastrointestinal mucosa following an acute intraabdominal infectious process. Early treatment of this condition using anticoagulation and endovascular thrombolysis as adjunctive therapies may prevent PVT complications.
authors.affiliation: Pikeville Medical Center, Infectious Diseases and Infectious Control, Pikeville Medical Center, USA.
authors.forename: Fadi Al
authors.initials: FA
authors.lastname: Akhrass
authors.affiliation: Pikeville Medical Center, Infectious Diseases and Infectious Control, Pikeville Medical Center, USA.
authors.forename: Lina
authors.initials: L
authors.lastname: Abdallah
authors.affiliation: Pikeville Medical Center, Infectious Diseases and Infectious Control, Pikeville Medical Center, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Berger
authors.affiliation: Pikeville Medical Center, Interventional Radiology, Pikeville Medical Center, USA.
authors.forename: Rami
authors.initials: R
authors.lastname: Sartawi
keywords: Fusobacterium necrophorum; Lemierre's syndrome; Local thrombolytic therapy; Porto-mesenteric vein thrombosis; Pylephlebitis