Abstract
Lemierre’s disease is characterized by sepsis, often with an oropharyngeal source, secondary septic emboli and internal jugular vein thrombosis (Lancet 1:701–3, 1936. Clin Microbiol Rev 20(4):622–59, 2007). Septic emboli affecting many bodily sites have been reported, including the lungs, joints, bones, and brain. The case report describes an unusual case of Lemierre’s disease in a 64 year old gentleman causing profound sepsis, acute kidney injury, bilateral iliopsoas abscesses and a right hand abscess. To our knowledge, this is the first reported case of Lemierre’s disease in the context of bilateral psoas abscesses, and highlights the ambiguity surrounding the definition of Lemierre’s disease. The clinical literature review highlights the difficulty in definitively diagnosing the condition and offers some suggestions for recognising and refining the diagnostic criterion of Lemierre’s.
Highlights
In 1936, Lemierre described a series of lethal anaerobic septicaemias caused by the anaerobic bacterium known today as Fusobacterium necrophorum
While we cannot conclusively prove that in our case profound fusobacterial sepsis originated as a consequence of oropharyngeal infection, the biopsies taken of the oropharynx do demonstrate an acute-on-chronic inflammation which would fit with the subsequent clinical manifestation of Lemierre’s Syndrome
The presence of substantial internal jugular vein (IJV) thrombosis in our case, while consistent with the literature, is controversial with respect to the fact that the patient had had a central venous catheter inserted for 3 days on Intensive Care Unit (ICU) prior to appropriate radiological investigations of the neck and the provenance of the thrombus is contestable
Summary
In 1936, Lemierre described a series of lethal anaerobic septicaemias caused by the anaerobic bacterium known today as Fusobacterium necrophorum. Septic metastasis to muscle has been described but is relatively rare [2-5] This case report describes an unusual case of Lemierre’s disease in a 64 year old gentleman causing profound sepsis, acute kidney injury, bilateral iliopsoas abscesses and a right hand abscess [6-76]. Case presentation A 64 year old gentleman presented to the A&E department of a district general hospital with lethargy, fever and lumbar back pain radiating to the groins of two days duration His background included hypertension managed with multiple medications, diet controlled type 2 diabetes mellitus, chronic back pain, latent peptic ulcer disease, and bilateral total hip and knee arthroplasties. 72 hours after admission the blood cultures returned a yield of F. necrophorum and subsequently tazocin and metronidazole were commenced He remained intubated for a further three days. The patient is well and not suffering from any residual disability
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