SESSION TITLE: Fellow Case Report Poster - Critical Care I
SESSION TYPE: Affiliate Case Report Poster
PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM
INTRODUCTION: We present a case of Lemierre Syndrome to bring awareness of the re-emergence of this clinicopathologic entity.
CASE PRESENTATION: A 20-year-old healthy female, three months postpartum, presented with progressive headaches and neck pain after an outpatient diagnosis of presumed viral pharyngitis due to rapid streptococcal antigen negativity. Quickly, she decompensated, arrested, and was intubated. Laboratory data revealed an elevated white blood cell count with left shift, thrombocytopenia, coagulopathy, transaminitis, and acute kidney injury. Chest x-ray revealed diffuse bilateral alveolar infiltrates. Computed tomography (CT) of the chest showed mixed ground glass and soft tissue opacities, concerning for septic emboli. Lumbar puncture was consistent with bacterial meningitis. CT neck demonstrated occlusive thrombosis of the right transverse sinus, sigmoid sinus, and superior right jugular vein with a non-occlusive thrombosis of the left internal jugular vein. CT head showed watershed ischemia throughout the cerebral and cerebellar hemispheres with a 5mm midline shift. Blood cultures grew Fusobacterium Necrophorum. This constellation is consistent with Lemierre Syndrome. Despite treatment with broad-spectrum antibiotics and heparin infusion, she progressively declined and life sustaining measures were withdrawn.