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. 2014 May 25:15:230-4.
doi: 10.12659/AJCR.890449. eCollection 2014.

The forgotten disease: Bilateral lemierre's disease with mycotic aneurysm of the vertebral artery

Tanush Gupta  1 , Kaushal Parikh  1 , Sonam Puri  2 , Sahil Agrawal  1 , Nikhil Agrawal  3 , Divakar Sharma  4 , Lawrence DeLorenzo  4
Affiliations

The forgotten disease: Bilateral lemierre's disease with mycotic aneurysm of the vertebral artery

Tanush Gupta et al. Am J Case Rep. .

Abstract

Patient: Male, 25 FINAL DIAGNOSIS: Lemierre's disease Symptoms: Back pain • fever • headache • tachycardia • tachypnoe

Medication: - Clinical Procedure: - Specialty: Infectious Diseases.

Objective: Rare disease.

Background: Lemierre's disease, also known as the forgotten disease, postanginal sepsis, or necrobacillosis, was first reported in 1890 by Courmont and Cade, but it was Dr. Andre Lemierre, a professor of microbiology, who described this disease in 1936. The typical causative agent is Fusobacterium necrophorum, although other organisms may be involved. The pathogenesis of Lemierre's disease is not well understood. It is characterized by a primary oropharyngeal infection associated with septicemia, internal jugular vein thrombosis, and metastatic septic emboli.

Case report: We report a case of Lemierre's disease with bilateral internal jugular vein (IJV) thrombosis and metastatic septic emboli to the lungs and brain, associated with epidural abscess and mycotic aneurysm of the vertebral artery, which is quite rare in Lemierre's disease. This is the first report of a case of Lemierre's disease associated with mycotic aneurysm of the vertebral artery.

Conclusions: Lemierre's disease is a rare and perplexing medical entity. Clinical suspicion should be high in previously healthy young adults presenting with fever and neck pain following oropharyngeal infection. Dr. Lemierre stated that 'symptoms and signs of Lemierre's disease are so characteristic that it permits diagnosis before bacteriological examination'. The prognosis of patients with Lemierre's disease is generally good, provided prompt recognition and appropriate treatment.

Keywords: Aneurysm; Infected – microbiology; Lemierre Syndrome; Thrombosis.

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Figures

Figure 1.
Figure 1.
CT Chest with contrast: There are numerous bilateral pulmonary nodules of varying sizes, ranging from under a millimeter to 2.5 cm in the superior segment of the left lower lobe. The more peripheral lesions are larger in size and demonstrate early central cavitation.
Figure 2.
Figure 2.
(A, B) CT angio head/neck: There is focal aneurysmal dilatation of the left vertebral artery at the C4 level; this may be secondary to infectious changes. No definite dissection is seen at this level.
See this image and copyright information in PMC

References

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