SESSION TYPE: Infectious Disease Student/Resident Case Report Posters I
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Lemierre’s syndrome is a rare complication of oropharyngeal infections that causes thrombophlebitis of the internal jugular vein, bacteremia, and metastatic foci of disease. We present a 19-year-old female who developed Lemierre’s syndrome due to Arcanobacterium haemolyticum.
CASE PRESENTATION: A healthy 19-year-old Hispanic female presented with a five day history of anorexia, myalgias, odynophagia, and sore throat. Physical exam was notable for diffusely swollen submandibular lymph nodes (right larger than left) and hyperaemic pharynx with exudate. She was admitted and required endotracheal intubation for hypoxic respiratory failure. Chest and neck CT scans revealed a right peritonsillar abscess, right internal jugular venous thrombophlebitis, and bilateral pulmonary septic emboli, which suggested a diagnosis of Lemierre’s syndrome (Figures 1 and 2). Within 24 hours of admission, two blood cultures grew gram variable rods, later confirmed to be Arcanobacterium haemolyticum. Her hospital course was complicated by a large tension pneumothorax as well as a complicated parapneumonic effusion. She was taken to the operating room for video-assisted thoracic surgery and partial decortication. On the twelfth day of hospitalization, she was successfully extubated and shortly after, she was discharged home to complete a course of IV Piperacillin-Tazobactam.
DISCUSSION: Lemierre’s syndrome is caused by an inciting infection, such as tonsillopharyngitis, sinusitis, or mastoiditis, which then extends to adjacent pharyngeal tissues and causes thrombophlebitis of the internal jugular vein. Metastatic septic emboli are a common complication of Lemierre’s syndrome and the lungs are the most commonly affected organ. These pulmonary infiltrates can cavitate and cause complications such as abscesses, pleural effusions, pneumothoraces, and empyemas. Fusobacterium necrophorum is usually the inciting infectious organism in Lemierre’s syndrome and our case is very unique as Arcanobacterium haemolyticum was the sole pathogen. Up to 2.5% of cases of pharyngitis are caused by A. haemolyticum, though it is very rarely implicated in systemic infections. This organism remains susceptible to most antibiotics and routine resistance has been reported only with trimethoprim/sulfamethoxazole.
CONCLUSIONS: We describe a case of pulmonary septic emboli and septic shock caused by Lemierre's syndrome from A. haemolyticum. This is the second report of Lemierre’s syndrome caused solely by A. haemolyticum. Providers should be aware that that pharyngitis associated with this organism can progress into serious systemic infections.
1) Chirinos J, Lichtstein D, Garcia J, Tamariz L. The evolution of Lemierre syndrome: report of two cases and review of the literature. Medicine. 2002;81:458-465.
2) Therriault B, Daniels L, Carter Y, Raasch R. Severe sepsis caused by Arcanobacterium haemolyticum: a case report and review of the literature. Ann Pharmacother. 2008;42:1697-1702.
DISCLOSURE: The following authors have nothing to disclose: Krista Edelman, Sammy Pedram, Dan Grinnan
No Product/Research Disclosure InformationVirginia Commonwealth University, Richmond, VA