Lemierre's Syndrome with a Palmar Lesion

Abstract

Lemierre's syndrome can be fatal if diagnosed late or not treated appropriately. We herein report a 40-year-old woman with a fever and pain with tenderness in her palms after the administration of antibiotics for pharyngotonsillitis. She was diagnosed with Lemierre's syndrome, and her symptoms improved after the administration of intravenous ampicillin-sulbactam. In this case, the palmar lesions indicated septic emboli and were an important finding in recognizing Lemierre's syndrome. Lemierre's syndrome should be considered in the differential diagnosis of patients with a persistent fever following oropharyngeal infection, even if they have received antimicrobial therapy, resolved pharyngeal symptoms, and negative culture results.

Keywords: Lemierre's syndrome; abscess; palmar lesion; septic emboli.

Figure 1.

The clinical course in this case. ABPC/SBT: ampicillin-sulbactam, AMPC/CVA: amoxicillin-clavulanate, AZM: azithromycin, CRP: C-reactive protein

Figure 2.

A photograph of the left hand of a 40-year-old woman showing significant swelling and redness in the palmar region.

Figure 3.

Axial (Panel A), coronal (Panel B), and sagittal (Panel C) contrast-enhanced computed tomography of the neck showing a filling defect of the left internal jugular vein (arrows).

Figure 4.

Axial contrast-enhanced computed tomography of the chest showing bilateral cavitary lung lesions with internal necrosis (arrows, Panel A) and intramuscular abscesses with ring enhancement around the scapula (arrows, Panel B).

Figure 5.

Axial magnetic resonance imaging of the left hand showing a high-intensity area in the thenar subcutaneous region on short tau inversion recovery (arrows, Panel A) and ring enhancement on contrast-enhanced T1-weighted sequence (arrows, Panel B), suggesting subcutaneous abscess.