A Rare Case of Lemierre's Syndrome due to Veillonella Parvula: A Dangerous and Forgotten Complication of a Septic Condition

Abstract

This clinical case presents an unusual case of Lemierre's syndrome (LS) in a young woman of 38-year-old. She arrived in the Emergency Department with a high fever and pharyngology resistant to antibiotic therapy with clarithromycin, ceftriaxone, and cortisone for two weeks. At the blood sampling, there is a marked leucocytosis, and the advice of the otolaryngologist is required given the strong pain in the throat. Due to the tonsillar abscess, a neck CT with a contrast medium is necessary for the otolaryngologist's opinion. The CT shows thrombosis of the jugular vein and left subclavian, with thickening of soft perivascular tissues; these findings suggest Lemierre's syndrome: a septic thrombophlebitis of the jugular vein that occurs as a complication of a peritonsillar abscess. The diagnostic process is then completed with a chest HR-CT, which reveals lung density and excavation areas suggesting tuberculosis. Blood culture reveals the presence of Veillonella Parvula (an anaerobic gram-negative coccus), sputum culture reveals the presence of some colonies of Enterobacter cloacae complex, real-time PCR examination on sputum reveals the presence of Streptococcus Pneumoniae and the borderline presence of rhinovirus. Microbiologists, after these results and neck and chest CT with a contrast agent, agree with the diagnosis of suspected LS at an early stage: a septic dissemination fortunately limited only to the neck and lungs region.

Keywords: Enterobacter cloacae; Leimerre’s syndrome; Oropharyngeal infection, thrombophlebitis; Septic emboli; Veillonella parvula; Vein thrombosis.

Fig. 1

A CT of the neck, with contrast medium, shows that there is thrombosis of the jugular vein and subclavian left with thickening of soft perivascular tissues (A) in the axial section; (B) in the coronal section; (C) in the sagittal section

Fig. 2

Angiotomography of the neck vessels. A filling defect is observed along the entire length of the left internal jugular vein

Fig. 3

The HR-CT of the chest reveals pulmonary densities and areas of excavations at the posterior-basal segment of the LIS and anteroposterior of LSD probable infectious hypothesis, also caused by Mycobacterium tuberculosis. A) and B), a coronal section and an axial section, show the condition on the apex of the lungs. C) and D), a coronal section and an axial section, show the condition of the basal parenchyma of the lungs

Fig. 4

The X-ray examination was performed in a single projection and showed a circumscribed parenchymal thickening at the level of the basal pulmonary field on the left. There is a dystelectasis stria at the peri-scissure site on the right, with traction relative to the pleura. Moderately thickened the peri-bronco vascular interstitial