719A Rare Variant of Lemierre's Syndrome – Fusobacterium necrophorum Sepsis from Gynecological Origin

Abstract

History: 19 year-old female presented with abdominal pain, nausea, vomiting and fever. Initially the patient denied any sexually transmitted diseases or recent pregnancy. Physical examination: Negative except severe pallor (+) Laboratory Values: Hemoglobin 2.9 g/dl, white blood cell count was normal 8000/microliter. Peripheral blood smear: no evidence of hemolysis, but severe microcytic anemia and thrombocytosis. Imaging: Abdominal and chest computerized tomography showed pelvic thrombophlebitis with extensive clot burden extending from common femoral vein to common iliac vessels with fluid in adenexa as well as segmental/sub-segmental pulmonary emboli. Other tests: Admission blood cultures grew Fusobacterium necrophorum on day 3. Hospital course: Detailed sexual history was taken again by a female medical resident and the patient revealed she had an abortion (not done by a medical professional). Diagnosis and Management: Keeping in mind . Lemierre’s syndrome is a rare, potentially severe disorder consisting of septic emboli from an internal jugular vein thrombus after oropharyngeal infection. There a few reports illustrating a variant of Lemierre’s syndrome with the female genital tract being the source. Case Report Background