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Case Reports
. 2023 Apr 21;16(4):e254638.
doi: 10.1136/bcr-2023-254638.

Complex Lemierre syndrome with multisystemic abscesses

Johan Bourgeaud  1 , Benoît Delabays  2 , Lorena Van den Bogaart  3 , Damian Ratano  4
Affiliations
Case Reports

Complex Lemierre syndrome with multisystemic abscesses

Johan Bourgeaud et al. BMJ Case Rep. .

Abstract

We present here the challenging case of severe Lemierre syndrome in a healthy woman in her late twenties, whose clinical presentation was characterised by lung abscesses and disseminated systemic abscesses in the brain, the abdomen and the soft-tissues, as a likely consequence of a patent foramen ovale. Blood cultures were positive for Fusobacterium necrophorum and a right lingual vein thrombosis was detected at a late stage when the patient developed a septic shock. Initial antimicrobial therapy with metronidazole and ceftriaxone was modified to meropenem due to progressive worsening. The patient underwent laparoscopy and neurosurgical drainage of a cerebral abscess. She spent many days in the intensive care unit and recovered fully after 6 weeks on meropenem therapy. Although considered rare, the incidence of Lemierre syndrome, a potentially life-threatening condition, is increasing. The clinician should promptly recognise and treat it while being aware of its potential atypical presentations.

Keywords: Ear, nose and throat/otolaryngology; Infectious diseases; Intensive care; Surgery.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Chest CT scan showing pulmonary nodules, one of which in the right lung is excavated (yellow arrow), consistent with septic pulmonary emboli.
Figure 2
Figure 2
Contrast-enhanced abdominal CT scan showing a pelvic abscess (yellow arrow).
Figure 3
Figure 3
Contrast-enhanced neck CT scan (A) and contrast-enhanced T1-weighted MRI (B) showing a right lingual vein thrombosis (yellow arrow). In contrast, there is normal enhancement of the left lingual vein (yellow arrowhead).
Figure 4
Figure 4
The typical radiological features of cerebral abscess are shown in the right frontal cortex (yellow arrows): (A) hypodensity on non-contrast CT of the brain, (B) T1-weighted with contrast MR sequence and rim enhancement, (C) diffusion-weighted MR sequence showing restricted diffusion and (D) hyperintense with a hypointense rim and peripheral oedema on T2-weighted MR sequence.
Figure 5
Figure 5
Contrast-enhanced abdominal CT-scan showing an abscess within the right gluteus maximus (yellow arrow).
See this image and copyright information in PMC

References

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