Lemierre’s Syndrome: Rare, but Life Threatening—A Case Report withStreptococcus intermedius

Shalini Gupta,Shehzad S Merchant

doi:10.1155/2012/624065

Abstract

Lemierre's syndrome (LS) is a rare, but a life-threatening complication of an oropharyngeal infection. Combinations of fever, pharyngitis, dysphagia, odynophagia, or oropharyngeal swelling are common presenting symptoms. Infection of the lateral pharyngeal space may result in thrombosis of the internal jugular vein, subsequent metastatic complications (e.g., lung abscesses, septic arthritis), and significant morbidity and mortality. LS is usually caused by the gram-negative anaerobic bacillus Fusobacterium necrophorum, hence also known as necrobacillosis. We present a case of LS caused by Streptococcus intermedius, likely secondary to gingival scraping, in which the presenting complaint was neck pain. The oropharyngeal examination was normal and an initial CT of the neck was done without contrast, which likely resulted in a diagnostic delay. This syndrome can be easily missed in early phases. However, given the potential severity of LS, early recognition and expedient appropriate antimicrobial treatment are critical. S. intermedius is an unusual cause of LS, with only 2 previous cases being reported in the literature. Therefore, an awareness of the myriad presentations of this syndrome, which in turn will lead to appropriate and timely diagnostic studies, will result in improved outcome for LS.

Highlights

Lemierre’s syndrome (LS) is a life-threatening, but a rare complication of an oropharyngeal infection [1]
A middle-aged woman presented to the emergency room (ER) with complaints of severe neck pain and occipital headaches for one week, which were not relieved with analgesics
Tonsillitis is the most common primary infection (87.1%) followed by mastoiditis (2.7%) and odontogenic infections (1.8%) [11, 12]. This is typically followed by invasion of the pharyngeal lateral wall and thrombophlebitis of the internal jugular vein followed by high grade bacteremia and septic seeding of vital organs, most commonly the lungs

Summary

Introduction

Lemierre’s syndrome (LS) is a life-threatening, but a rare complication of an oropharyngeal infection [1]. Lemierre’s syndrome was associated with a case-mortality rate of 32%–90%, with embolic events in 25% and endocarditis in 12.5% of the patients. It is still a potentially life-threatening disease with a reported mortality of up to 17% [2]. The suggested diagnostic criteria are (1) history of recent oropharyngeal infection, (2) clinical or radiographic evidence of thrombophlebitis of the internal jugular vein (IJV), and (3) isolation of an anaerobic pathogen [1, 3]. To the best of our knowledge, this is the first case report of LS with Streptococcus intermedius in an immunocompetent adult resulting from a gingival procedure with a normal oropharyngeal examination at the time of presentation

Case Presentation

Discussion

Findings

Summary

Conflict of Interests