A Case of Embolic Spread of Fusobacterium necrophorum From Presumed Pharyngitis

Abstract

Fusobacterium necrophorum is the most common pathogen isolated in individuals diagnosed with the rare and life-threatening illness known as Lemierre's syndrome. Lemierre's syndrome commonly involves a triad of infection in the oropharyngeal region, thrombophlebitis of the internal jugular vein, and distant metastases of said infection. Our case involves an embolic spread of F. necrophorum to the lungs, which was presumed to have originated in the pharynx, in the absence of internal jugular vein thrombosis. The clinical course of the patient was further complicated by an initial diagnosis of community-acquired pneumonia, severe sepsis, and disseminated intravascular coagulation. After suitable input from the multi-disciplinary team and adequate antibiotic therapy, the patient demonstrated a positive outcome with complete recovery to her baseline.

Keywords: fusobacterium necrophorum; lemierre's syndrome; pharyngitis; sepsis; thrombophlebitis.

Figure 1. Chest X-ray on presentation.

Chest X-ray taken on presentation at the Accident and ED showing focal consolidation in both lung fields in keeping with severe community-acquired pneumonia.

Figure 2. Chest CT with contrast.

Chest CT scan demonstrating septic emboli (arrow).

Figure 3. Chest CT with contrast.

Chest CT scan demonstrating multiple lung cavitations (arrow).

Figure 4. Chest X-ray one month after discharge.

Chest X-ray taken one month after discharge from hospital demonstrating only partial improvement in consolidation.

Figure 5. Chest X-ray three months after discharge.

Chest X-ray taken three months after discharge from hospital demonstrating complete resolution of changes demonstrated earlier.