Abstract
IntroductionLemierre's syndrome is septic thrombophlebitis of the internal jugular vein leading to metastatic septic complications following an oropharyngeal infection. It is usually caused by the anaerobe, Fusobacterium necrophorum. Of late, meticillin-resistant Staphylococcus aureus is increasingly being recognised as a cause of community-acquired skin and soft tissue infections. We report a rare case of Lemierre's syndrome caused by community-acquired meticillin-resistant Staphylococcus aureus infection.Case presentationA previously healthy 16-year-old girl presented with fever of 13 days duration, painful swelling around the right eye and diplopia followed by the appearance of pulmonary infiltrates. Imaging studies confirmed the clinical suspicion of bilateral jugular venous thrombosis with septic pulmonary embolism. Meticillin-resistant Staphylococcus aureus was isolated on blood cultures. The hospital course was complicated by massive haemoptysis and pulmonary aspiration necessitating mechanical ventilation. The patient subsequently made a complete recovery.ConclusionLemierre's syndrome, although rare, is a potentially lethal but treatable complication of head and neck sepsis. Early clinical recognition of Lemierre's syndrome and appropriate antibiotic treatment can be life-saving. One should consider the possibility of community-acquired meticillin-resistant Staphylococcus aureus infection in patients with suspected Lemierre's syndrome.
Highlights
Lemierre's syndrome is septic thrombophlebitis of the internal jugular vein leading to metastatic septic complications following an oropharyngeal infection
One should consider the possibility of community-acquired meticillin-resistant Staphylococcus aureus infection in patients with suspected Lemierre's syndrome
Over the past few years, it is being increasingly reported as an important cause of serious skin and soft tissue infections acquired in the community among individuals without any of the conventionally recognised risk factors for MRSA infection [3]
Summary
Physicians need to be aware of Lemierre's syndrome as a rare but potentially lethal complication of head and neck sepsis. With the emergence of CA-MRSA, one should keep in mind the possibility of CA-MRSA infection in patients with suspected Lemierre's syndrome. Written informed consent could not be obtained in this case since the patient is lost to follow-up. We believe that this case report contains a worthwhile clinical lesson which could not be made as effectively in any other way. We expect that the patient and her family would not object to the publication since every effort has been made so that she remains anonymous
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