An Atypical Presentation of Lemierre’s Syndrome: Complicated by Thrombotic Thrombocytopenic Purpura

Bryan Vera Nieves,Geoffrey Lindblad,Jessica Hughes,Javas Gupta,Andres Rivero

doi:10.7759/cureus.12728

Abstract

Lemierre’s syndrome is an oropharyngeal infection complicated by septic thrombophlebitis of the internal jugular vein, bacteremia, and septic emboli. It mainly occurs in immunocompetent individuals and was first reported in the early 1900s by physician Andre Lemierre. A 23-year-old male presented to our institution with sore throat, difficulty swallowing, left-sided ear pain, nausea, vomiting, subjective fevers, general malaise, right-sided rib pain, and anorexia. Complete blood cell count and metabolic panels revealed severe thrombocytopenia, mild anemia, acute kidney injury, and hyperbilirubinemia. Blood cultures grew Fusobacterium necrophorum. Ultrasound and computed tomography scan of the neck revealed thrombosis of the left internal jugular vein. ADAMTS13 activity was later reported to be markedly decreased at less than 2%, confirming a diagnosis of thrombotic thrombocytopenic purpura.

Highlights

Lemierre’s syndrome is a rare condition characterized by septic thrombophlebitis of the internal jugular vein and bacteremia
Lemierre’s syndrome is an oropharyngeal infection complicated by septic thrombophlebitis of the internal jugular vein, bacteremia, and septic emboli
We report a case of Lemierre’s syndrome complicated by thrombocytopenic purpura (TTP)

Summary

Introduction

Lemierre’s syndrome is a rare condition characterized by septic thrombophlebitis of the internal jugular vein and bacteremia. It usually occurs following a recent oropharyngeal infection and is frequently complicated by septic emboli [1,2,3,4]. After a benign appearing evaluation, the patient was discharged from the emergency department with prednisone, ondansetron, and ibuprofen His symptoms persisted over the following 10 days and he decided to seek further care at our institution. After finishing antibiotic and anticoagulation therapy, repeat neck ultrasound showed resolution of the internal jugular vein thrombus, as well as normalization of his complete blood cell count and complete metabolic panel. Our patient made a full recovery with no lasting complications

Discussion

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Disclosures