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Lemierre syndrome

Lemierre syndrome is a rare condition arising from an invasive oropharyngeal infection, which leads to septic thrombophlebitis of the internal jugular vein and multi-organ septic embolization most commonly by Fusobacterium necrophorum.

This disease entity should be included in the differential diagnoses of CNS bacterial infections 1).

A high index of suspicion and early recognition is important for successful management and to prevent systemic complications like multiorgan failure with extremely high morbidity, prolonged hospitalization and, not uncommonly, death.

Intracranial complications are rare but serious, including subdural empyema, cavernous sinus thrombosis, and internal carotid artery aneurysms.

Its an unusual manifestation of spinal infection 2).

A patient with Lemierre syndrome with multiple intracranial complications despite aggressive antimicrobial therapy, required transsphenoidal endoscopic drainage of the sphenoid sinus to help eradicate the infectious source and can be an adjunct to antimicrobial therapy in achieving infection control.

Lemierre syndrome with cervical spondylodiscitis and epidural abscess associated with direct injection of heroin into the jugular vein 3).

A 16-year-old boy with cavernous sinus thrombosis and right internal carotid artery narrowing without neurological sequelae, right subdural empyema, and cerebritis in the right temporal and occipital lobes. Neuroimaging also demonstrated right jugular vein thrombosis. Cultures of samples from the blood proved positive for the presence of Fusobacterium necrophorum. The patient underwent unilateral tonsillectomy, drainage of the peritonsillar abscess, and a myringotomy on the right side. Postoperatively the patient was treated conservatively with antibiotic therapy resulting in an excellent outcome 4).

Teng HW, Chen CY, Chen HC, Chung WT, Lee WS. Fusobacterium septicemia complicated by cerebral subdural and epidural empyemas: a rare case of Lemierre syndrome. J Emerg Med. 2012 Oct;43(4):671-3. doi: 10.1016/j.jemermed.2010.04.033. Epub 2010 Jun 20. PubMed PMID: 20566261.
Park D, Rezajooi K, Sabin I. Lemierre's syndrome: an unusual manifestation of spinal infection. J Bone Joint Surg Br. 2006 Feb;88(2):261-2. PubMed PMID: 16434535.
Lin HY, Liao KH, Jean SS, Ou TY, Chen FL, Lee WS. Lemierre syndrome with cervical spondylodiscitis and epidural abscess associated with direct injection of heroin into the jugular vein. J Microbiol Immunol Infect. 2013 Dec 30. pii: S1684-1182(13)00231-4. doi: 10.1016/j.jmii.2013.11.008. [Epub ahead of print] PubMed PMID: 24388576.
Westhout F, Hasso A, Jalili M, Afghani B, Armstrong W, Nwagwu C, Ackerman LL. Lemierre syndrome complicated by cavernous sinus thrombosis, the development of subdural empyemas, and internal carotid artery narrowing without cerebral infarction. Case report. J Neurosurg. 2007 Jan;106(1 Suppl):53-6. PubMed PMID: 17233314.
lemierre_syndrome.txt · Last modified: 2014/10/19 13:36 (external edit)