Your browser doesn't support javascript.
Early Clinical Interventions Dictate Favorable Outcomes: A Case of Lemierre Syndrome
Critical Care Medicine ; 51(1 Supplement):175, 2023.
Artigo em Inglês | EMBASE | ID: covidwho-2190520
ABSTRACT

INTRODUCTION:

Lemierre's syndrome (LS) is characterized by fever, sore throat, neck swelling and tenderness, and septic thrombophlebitis of the jugular vein. It remains a fatal disease as serious complications commonly arise. DESCRIPTION 20-year-old male patient with not known past medical history endorsed 1 week of sore throat, emesis, loose stools, weight loss as well as dyspnea associated with bilateral, non-pleuritic chest pain, night sweats, myalgias and subjective fever sensation. Patient was initially hypoxic, hypotensive, tachycardic, tachypneic and febrile, with scleral icterus, lymphadenopathy of neck and jaw bilaterally, enlarged tonsils, and diffuse abdominal tenderness. Laboratory results showed leukocytosis with neutrophile predominance, anemia, thrombocytopenia, elevated inflammatory markers. There was also pre-renal acute kidney injury, elevated alkaline phosphatase and hyperbilirubinemia. SARS-CoV-2 tests were negative. Initial computerized tomography (CT) of the chest showed extensive peripheral ground-glass nodules and rounded consolidations, with lower lobe predominance. Admission to medical ICU was warranted. Initial blood cultures showed no identification of speciation;Ceftriaxone was started with satisfactory response. However, patient developed worsening shortness of breath, orthopnea, rightsided neck pain and erythema. Repeat imaging showed new airspace opacities in both lungs with cavitation consistent with septic emboli, and thrombophlebitis of right jugular vein with no abscess. At that point, blood cultures grew Fusobacterium necrophorum and metronidazole was started. A four-week course was completed upon discharge with satisfactory response.

DISCUSSION:

Lemierre's syndrome remains as a rare but potentially fatal entity. Internal jugular vein (IJV) thrombophlebitis occurs through infection of the lateral pharyngeal space. Pulmonary metastases are common. Metronidazole comprises the foundation of the treatment given its tissue penetration and activity against all strains of Fusobacterium spp. Data regarding anticoagulation efficacy is limited. Clinicians should maintain high clinical suspicion, and a multidisciplinary approach with broad collaboration among specialties is imperative to aid early diagnosis and better clinical outcomes.
Palavras-chave

Texto completo: Disponível Coleções: Bases de dados de organismos internacionais Base de dados: EMBASE Tipo de estudo: Estudo experimental / Estudo prognóstico Idioma: Inglês Revista: Critical Care Medicine Ano de publicação: 2023 Tipo de documento: Artigo

Similares

MEDLINE

...
LILACS

LIS


Texto completo: Disponível Coleções: Bases de dados de organismos internacionais Base de dados: EMBASE Tipo de estudo: Estudo experimental / Estudo prognóstico Idioma: Inglês Revista: Critical Care Medicine Ano de publicação: 2023 Tipo de documento: Artigo