Advanced Lemierre syndrome requiring surgery

Escher, R; Haltmeier, S; von Steiger, N; Dutly, A E; Arnold, A; Kickuth, R; Schiemann, U (2008). Advanced Lemierre syndrome requiring surgery. Infection, 36(5), pp. 495-6. Heidelberg: Urban and Vogel 10.1007/s15010-008-8216-7

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A 38-year-old homeless man was admitted with a 2-week history of a sore throat, increasing shortness of breath, and high fever. Clinical examination showed enlarged and tender submandibular and anterior cervical lymph nodes and a pronounced enlargement of the left peritonsillar region (Figure 1a). CT scan of the throat and the chest showed left peritonsillar abscess formation, occlusion of the left internal jugular vein with inflammatory wall thickening and perijugular soft tissue infiltration, pulmonary abscesses, and bilateral pleural effusions (Figures 1b-e, arrowed). Anaerobe blood cultures grew Fusobacterium necrophorum, leading to the diagnosis of Lemierre's syndrome. Treatment with high-dose amoxicillin and clavulanic acid improved the oropharyngeal condition, but the patient's general status declined further, marked by dyspnea and tachypnea. Repeated CT scans showed progressive lung abscesses and bilateral pleural empyema. Bilateral tonsillectomy, ligation of the left internal jugular vein, and staged decortication of bilateral empyema were performed. Total antibiotic therapy duration was 9 weeks, including a change to peroral clindamycin. Clinical and laboratory findings had returned to normal 12 weeks after surgery.The patient's history and the clinical and radiological findings are characteristic for Lemierre's syndrome. CT scans of the neck and the chest are the diagnostic methods of choice. F. necrophorum is found in over 80% of cases of Lemierre's syndrome and confirms the diagnosis. Prolonged antibiotic therapy is usually sufficient, but in selected patients, a surgical intervention may be necessary. Reported mortality rates are high, but in surviving patients, the recovery of pulmonary function is usually good.

Item Type:

Journal Article (Original Article)

Division/Institute:

?? DCD5A442B9C7E17DE0405C82790C4DE2 ??
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Ear, Nose and Throat Disorders (ENT)
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Escher, Robert; Arnold, Andreas Michael; Kickuth, Ralph and Schiemann, Uwe Kurt

ISSN:

0300-8126

ISBN:

18791836

Publisher:

Urban and Vogel

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 15:04

Last Modified:

24 Oct 2019 22:40

Publisher DOI:

10.1007/s15010-008-8216-7

PubMed ID:

18791836

Web of Science ID:

000259784000019

BORIS DOI:

10.7892/boris.27745

URI:

https://boris.unibe.ch/id/eprint/27745 (FactScience: 110685)

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