Acute Cerebellar Stroke of Unclear Etiology Complicated by Lemierre’s Disease and Papillary Thyroid Carcinoma (P2-10.001)

Abstract

<h3>Objective:</h3> NA <h3>Background:</h3> Lemierre’s Disease is a rare condition that is usually caused by bacterial oropharyngeal infection, most common organism being Fusobacterium necrophorum, that is complicated by thrombophlebitis of the internal jugular vein. Below, is a case in which our stroke patient was found to have Lemierre’s Disease after obtaining a Karius panel. <h3>Design/Methods:</h3> Chart review for case report presentation. <h3>Results:</h3> 53-year-old female with no known medical history presented with headache, nausea, vomiting, fever and chills for three days. Lumbar puncture obtained was suggestive of bacterial source with elevated WBCs, nucleated cells with neutrophilic predominance, though her meningitis/encephalitis PCR panel was negative. Broad spectrum antibiotics was started. MRI brain showed a large ischemic right cerebellar infarct with mass effect. CTA of the head and neck, CT venography and MR venography showed nonocclusive thrombi of right proximal internal jugular vein and sigmoid sinuses. Repeat scans showed increasing hydrocephalus requiring EVD placement with eventual removal after improvement of mental status and serial imaging. Karius panel was positive for Fusobacterium nucleatum and porphyromonas gingivalis, and patient’s antibiotics was narrowed to reflect results. CT maxillofacial and neck showed extensive cervical lymphadenopathy and multiple periapical lucencies in teeth. IR guided cervical lymph node biopsies confirmed papillary thyroid carcinoma. Dentistry removed patient’s affected teeth. <h3>Conclusions:</h3> Although our patient had a large ischemic infarct, the more concerning issue was her concurrent meningitis from a bacterial source that caused a hypercoagulable state. With the Karius panel’s result, we promptly localized the infection and adjusted the patient’s antimicrobial management accordingly. Her clinical presentation continued to improve with treatment, and she was discharged to acute rehabilitation. Given the Karius panel’s rapid turnaround, in comparison to other metagenomic sequencing of CSF, we conclude that it is imperative to consider utilizing Karius panel testing for meningitis evaluation, especially in the setting of unremarkable meningitis/encephalitis PCR panel. <b>Disclosure:</b> Dr. Ho has nothing to disclose. Dr. Long has nothing to disclose. Dr. Kronfeld has nothing to disclose.