Lung abscess as a complication of Lemierre Syndrome in adolescents: a single center case reports and review of the literature

Abstract

Background: Fusobacterium necrophorum is an anaerobic, gram-negative, non-motile, filamentous, non-spore forming bacillus found in the oral cavity, gastrointestinal tract, and female genital tract, responsible of a rare disease named Lemierre Syndrome, characterized by septic thrombophlebitis of the internal jugular vein, which mainly affects previously healthy adolescents and young adults; some risk factors are reported, as smoking or primary viral or bacterial infection leading to the disruption of mucosa. The syndrome originates commonly from an upper respiratory infection such as pharyngotonsillitis, acute otitis media, cervical lymphadenitis, sinusitis, or odontogenic abscess, and may result in multiorgan metastasis, more frequently leading to pulmonary complications, especially lung abscesses.

Case presentation: We describe two cases of adolescents with atypical Lemierre Syndrome evaluated in a tertiary care center, one with a confirmed infection by Fusobacterium necrophorum and one with a presumptive diagnosis based on clinical features, who developed lung abscesses needing a prolonged antibiotic course and hospitalization. Of interest, both were user of electronic cigarette, configuring a possible new risk factor. The proper diagnosis of Lemierre Syndrome is often difficult to establish, so a high degree of suspicion is needed, especially in the case of lung abscesses in otherwise healthy adolescents.

Conclusion: The current study will contribute to providing insight into Lemierre Syndrome clinical presentation and management in adolescents, promoting awareness for a rare but potentially fatal disease. Moreover, it suggests a possible relationship between Lemierre syndrome and the use of electronic cigarette, that should be investigated by future studies.

Keywords: Adolescents; Case report; EVALD; Fusobacterium necrophorum; Lemierre syndrome; Lung abscess.

Fig. 1

Axial, contrast-enhanced CT scan detecting a lung abscess of 3 cm in the left inferior pulmonary lobe (dashed line) (a). Sagittal, Contrast-enhanced CT scan showing a retropharyngeal abscess (*) (b)

Fig. 2

Coronal, post-contrast CT scan showing the left anterior jugular vein and left internal jugular vein thrombosis (a-b). Sagittal, contrast-enhanced CT scan showing the major blood vessels on the left side of the neck, the anterior jugular vein, and internal jugular vein thrombosis (c). ajv: anterior jugular vein; cca.: common carotid artery; eca: external carotid artery; ica: internal carotid artery; ijv: internal jugular vein; va: vertebral artery

Fig. 3

Contrast-enhanced CT scan of the thorax showing multiple lung abscesses (arrowhead) located in the right lower lobe (a); right upper lobe (b); middle lobe (c); left lower lobe (d)