Lemierre’s Syndrome in a Young Adult

Abstract

tion was requested. A factor VII, Protein C & S were ordered, and a diagnosis of partial disseminated intravas cular coagulation with thrombocytopenia was made. Although the patient developed a profound anemia, no transfusions were given. Chemistry profiles showed normal amylase and lipase, increased alkaline phosphatase, increased total and direct bilirubin, decreased total protein and albumin, and a decreased total calcium level. The patient developed a prerenal azotemia with a BUN:CREAT ratio of >20:1 and an estimated fluid deficit of approximately (-)570cc. The patient’s nutritional status was poor due to decreased oral intake. Since the patient’s oral intake remained poor, total parenteral nutrition (TPN) was initiated in the PICU. Liver enzymes of the patient remained stable, with only a slight increase in the alanine transaminase (ALT). A MRI of the patient’s brain was normal. A CT scan of the abdomen/chest/pelvis with contrast showed bilateral pleural effusions, bilateral pulmonary emboli, and bibasilar lower lobe atelectasis. After infectious disease consult, the patient was placed on penicillin every 4 hours and metronidazole every 6 hours. The patient also received Lovenox (low molecular weight heparin) every 12 hours for embolic prophylaxis. After several days in the PICU, the patient was transferred to the general medical floor where she continued to gradually improve. Background on Lemierre’s