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Lemierre’s disease: a case with bilateral iliopsoas abscesses and a literature review

Abstract

Lemierre’s disease is characterized by sepsis, often with an oropharyngeal source, secondary septic emboli and internal jugular vein thrombosis (Lancet 1:701–3, 1936. Clin Microbiol Rev 20(4):622–59, 2007). Septic emboli affecting many bodily sites have been reported, including the lungs, joints, bones, and brain. The case report describes an unusual case of Lemierre’s disease in a 64 year old gentleman causing profound sepsis, acute kidney injury, bilateral iliopsoas abscesses and a right hand abscess. To our knowledge, this is the first reported case of Lemierre’s disease in the context of bilateral psoas abscesses, and highlights the ambiguity surrounding the definition of Lemierre’s disease. The clinical literature review highlights the difficulty in definitively diagnosing the condition and offers some suggestions for recognising and refining the diagnostic criterion of Lemierre’s.

Background

In 1936, Lemierre described a series of lethal anaerobic septicaemias caused by the anaerobic bacterium known today as Fusobacterium necrophorum. A group of these patients suffered from “postanginal septicaemias”, characterized by internal jugular vein thrombosis and septic emboli with a focus within the head and neck [1]. Septic emboli affecting many body sites have been reported, including the lungs, joints, bones, liver, brain and meninges. Septic metastasis to muscle has been described but is relatively rare [25]. This case report describes an unusual case of Lemierre’s disease in a 64 year old gentleman causing profound sepsis, acute kidney injury, bilateral iliopsoas abscesses and a right hand abscess [676].

Case presentation

A 64 year old gentleman presented to the A&E department of a district general hospital with lethargy, fever and lumbar back pain radiating to the groins of two days duration. His background included hypertension managed with multiple medications, diet controlled type 2 diabetes mellitus, chronic back pain, latent peptic ulcer disease, and bilateral total hip and knee arthroplasties. On examination, he was hypoxic (94% oxygen saturation), hypothermic (35.6°C) and tachycardic with new onset, fast atrial fibrillation (rate 142/minute), but normotensive. In addition, he was diffusely tender in the supra-pubic region and in both loins, especially on the right. Neurological examination was normal other than MRC grade 4/5 power in the lower limbs.

Blood tests demonstrated a marked inflammatory response with raised CRP (373 mg/L) and predominantly neutrophilic leucocytosis (20.5 × 109/L). Acute kidney injury (urea 31.4 mmol/L; creatinine 244 μmol/L) and mildy deranged liver function tests (alkaline phosphatase 343 IU/L; GGT 183 IU/L; ALT 52 IU/L; bilirubin 14 μmol/L) were evident. Arterial blood gases demonstrated a metabolic acidosis (pH 7.32; base excess −8 mEq/L). A chest radiograph was normal. Urinalysis was positive for leucocytes and erythrocytes only. Blood cultures were taken and broad spectrum antibiotics were commenced for presumed urosepsis.

24 hours after admission, the right hand became diffusely swollen, erythematous and tender, and the patient continued to experience pyrexia. His urine cultures yielded Serratia marcescens sensitive to the antibiotics. Ultrasonography of the urinary tract failed to demonstrate hydronephrosis. Ultrasonography of the right hand showed generalised soft tissue oedema with a 1 cm deep fluid filled collection containing echogenic material overlying the MCP joints.The following day, the acute kidney injury worsened (urea 43.4 mmol/L; creatinine 351 μmol/L). An urgent CT thorax/abdomen/pelvis demonstrated an unexpected finding of bilateral iliopsoas abscesses, most extensive on the right side which contained a considerable volume of gas (Figures 1 and 2).

Figure 1
figure1

Transverse view on CT of the bilateral iliopsoas abscesses.

Figure 2
figure2

CT demonstrated Sagittal View of Abdomen and Pelvis demonstrating gas locules in Right Iliopsoas Region.

The patient proceeded to theatre for drainage of the abscesses. During intubation the anaesthetist noted the oropharynx was sloughy and inflamed and accordingly biopsies were taken. Bilateral groin incisions were used to approach the iliopsoas muscles in the extra-peritoneal plane. On the right side the abscess cavity involved the entire length of the iliopsoas muscle and contained 100 ml of cream coloured pus as well as gas. On the left side an estimated 40 ml of pus was contained within the lower psoas muscle. There was no evidence of communication with the replaced hip joints on either side. Drains were placed into the cavities. The hand abscess was also drained and samples from all sites were sent to microbiology. The patient was then transferred post-operatively to ICU for inotropic support (noradrenaline) and ongoing fluid resuscitation.

72 hours after admission the blood cultures returned a yield of F. necrophorum and subsequently tazocin and metronidazole were commenced. He remained intubated for a further three days. An echocardiogram was largely unremarkable. The oropharyngeal biopsies demonstrated, particularly in the vallecula, acute-on-chronic infection but no discrete microbial growth was achieved. The other microbiological samples did not yield any growth on extended culture runs. Subsequent neck ultrasonography confirmed a partially occlusive right internal jugular vein thrombus at the subclavian confluence (Figure 3). A CT neck/thorax confirmed this but did not demonstrate other occult pathology. Anticoagulation therapy with warfarin was subsequently commenced. The patient is now well and not suffering from any residual disability.

Figure 3
figure3

>50% occlusive right internal jugular vein thrombus on ultrasonography.

Discussion

Despite reports of human illnesses caused by what is now known as F. necrophorum appearing within early 20th Century literature, the consensus definition of Lemierre’s syndrome remains unclear [5, 77]. The authors undertook a literature review to further clarify these diagnostic criteria. Using the PubMed search engine we utilised the following mesh headings: Lemierre’s (All Text); and Fusobacterium (All Text); and Case (Title/Abstract).

The search yielded 96 papers published since 1980 from a wide global geographical area inclusive of Asia, South America, North America and Europe. The authors used only papers which had symptomatic descriptions, bacteriological evidence, radiological evidence and descriptions in English which could possibly demonstrate a definitive diagnosis of Lemierre’s disease. This left 78 identifiable cases in the literature.

Analysis of the 78 cases demonstrates that the oropharynx tends to be the primary infective site with 59/78 (77% - see Table 1) of all cases demonstrating symptoms prior to sepsis of an acute oropharyngeal infection. 16/78 (21%) of the remaining cases had primary infective sites from other anatomical locations. 5/78 (6%) of these cases originated in the ears with symptoms of otitis externa occurring prior to widespread sepsis. 3/78 (4%) cases originated in the soft tissues in the neck from originally superficial infections of the skin in both the anterior (2/3 cases) and the posterior (1/3 cases) triangles. 3/78 (4%) of cases had syndromic components but no obvious primary infective site.

Table 1 Site of primary infection

A particularly contentious aspect is whether or not the presence of thrombophlebitis of the internal jugular vein is essential in the diagnosis [77]. In our case, ultrasound and CT confirmed the presence of substantial internal jugular vein (IJV) thrombus. Our literature review demonstrated 54/78 (69% - see Table 2) of reported cases had thrombus in the IJV. In 2/78 (3%) of cases the IJV thrombus propagated cranially resulting in thrombophlebitis of the cranial veins. In both cases there were headache symptoms but no dynamic neurology. 18/78 (23%) of patients had thrombophlebitis in other anatomical locations which correlated with an ipsilateral local primary infective site. An unusual example of this is a case of thrombophlebitis of the ovarian vein in a case of fusobacterial sepsis from an Intra-Uterine Device [30]. 4/18 (22%) of these cases involved peritonsillar abscesses with ipsilateral facial vein involvement and substantial cellulitis of the face and neck region. 6/18 (33%) of cases of alternative anatomical sites for thrombophlebitis were the great veins of the cranium with the cavernous sinus and the sigmoid sinus being involved individually in 1/18 (5%) cases respectively. There were 2/18 (11%) cases of clot propagation distally from the cavernous sinus to the sigmoid sinuses. 1/18 (5%) cases demonstrated thrombophlebitis in the vasculature near the site of infective metastasis indicating that fusobacterial sepsis produces a highly pro-coagulant inflammatory response in patients [60]. This effect is demonstrated in the 2/78 (3%) cases where there was thrombus formation within the carotid artery [45, 61], a vessel with typically very high laminar flows which, according to Virchow’s triad, would preclude against clot formation and aggregation.

Table 2 Site of thrombus formation

The 78 individual patients produced 105 metastatic abscess sites indicating that multiple sites of metastases are a common feature of Lemierre’s syndrome (see Table 3). The most common site of metastasis is to the lungs which occurred in 55/105 (52%) metastatic sites and 55/78 (70%) of individual cases. 10/105 (9%) of metastases occurred in other soft tissue areas, of which 7/10 (70%) had concomitant pulmonary metastases. 6/105 (5%) metastatic sites were in the joints with 2/6 (33%) of these having associated pulmonary metastases. 18/105 (17%) metastases were to solid organs and bones. 12/18 (69%) soft tissue metastases occurred with pulmonary metastases. Therefore 21/55 (37%) of patients with pulmonary metastases developed further metastatic abscesses throughout the body with the most common metastases being to solid organs in 12/21 cases (60%). 12/18 (67%) of the metastases were to the cranial vault including cerebral (4/12), subdural (3/12) and epidural (2/12) anatomical locations. 4/12 (33%) of the cranial vault metastases had no pulmonary metastases. All of these cases had extensive cranial vein thrombophlebitis and, in 1 case, carotid artery thrombus.

Table 3 Site of metastatic spread and progression to surgery

The primary method of treatment of Lemierre’s Syndrome is through the use of broad-spectrum antimicrobials and supportive treatment. Surgery was utilised as a treatment modality in 24/78 (31%) cases in an attempt to gain source control in patients with refractory sepsis. Despite the presence of extensive pulmonary metastases which would make anaesthesia more dangerous, the surgical cohort had a 0% mortality rate while the overall cohort had a mortality rate of 4/78 (5%). 3 of the fatal cases were at the extremes of age, being 79 [18], 80 [50] and 10 years old respectively [43], with multiple metastatic sites and severe sepsis. The remaining fatality was a 34 year old gentleman with a delayed presentation to hospital one week post-onset of systemic symptoms with metronidazole resistant fusobacterial sepsis and multiple metastatic sites including heart valve vegetations [14]. Although this cohort is small it would seem to indicate that the outcomes are poorer for patients with reduced physiological reserve, locally advanced inflammation and multiple metastatic sites.

Conclusion

Riordan has previously highlighted the epistemological difficulty in definitively diagnosing Lemierre’s as a distinct disease entity [77]. Indeed there are numerous terms and diagnostic classifications utilised inchoately by multiple authors but Riordan argues that Lemierre’s should be confined to fusobacterium necrophorum sepsis originating in the oropharynx. While we cannot conclusively prove that in our case profound fusobacterial sepsis originated as a consequence of oropharyngeal infection, the biopsies taken of the oropharynx do demonstrate an acute-on-chronic inflammation which would fit with the subsequent clinical manifestation of Lemierre’s Syndrome. The anaerobic blood cultures grew fusobacterium necrophorum which is the vital component for a diagnosis of Lemierre’s disease and is the only consistent component of the three general terms of necrobacillosis, post-anginal sepsis and Lemierre’s syndrome utilised in the medical literature.

The presence of substantial IJV thrombosis in our case, while consistent with the literature, is controversial with respect to the fact that the patient had had a central venous catheter inserted for 3 days on ICU prior to appropriate radiological investigations of the neck and therefore the provenance of the thrombus is contestable. There is debatable evidence regarding the length of time a central venous catheter needs to be in situ before occlusive thrombus forms. Some studies have suggested that less than 3 days with a central catheter in-situ can cause small thrombus formation [6, 7]. However other equally robust studies have suggested that a central venous catheter needs to be in-situ for approximately 11 days to develop extensive occlusive thrombus [8] as demonstrated in our case. The literature review demonstrated that 31% of all cases did not have thrombosis of the IJV, however there were only 3/78 (4%) of cases with no associated thrombosis. Therefore thrombosis in the presence of fusobacterial bacteraemia would be a more appropriate diagnostic criterion than defining the disease by specific anatomically located thromboses.

In the context of the literature our case was unusual in that it demonstrated unique anatomical variation of the metastases and required surgery as the primary modality of treatment. Our patient did not have any pulmonary metastases which some authors have argued is a key diagnostic criterion for Lemierre’s syndrome [5]. However, our literature review has demonstrated that 30% of the cases had no pulmonary involvement. In view of this fact the authors support Riordan’s suggestion that Lemierre’s Syndrome should be reconstituted as fusobacterium necrophorum sepsis, however with the additional diagnostic criterion of the presence of thrombosis. It would seem that the septic metastases are a common complication of the syndrome with huge anatomical variation and as such are not essential to diagnose the condition.

Consent

Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Abbreviations

CRP:

C - Reactive Protein

Mg/l:

milligrams per litre

μmol/L:

micromols per litre

mmol/L:

millimols per litre

IU/L:

International Units per litre

GGT:

gamma glutamyl-transpeptidase

ALT:

Alanine Aminotransferase

CT:

Computed Tomography

MCP:

Metacarpophalangeal

ICU:

Intensive Care Unit

IJV:

Internal Jugular Vein.

References

  1. 1.

    Lemierre A: On certain septicemias due to anaerobic organisms. Lancet. 1936, 1: 701-703.

    Article  Google Scholar 

  2. 2.

    Kleinman PK, Flowers RA: Necrotising pneumonia after pharyngitis due to Fusobacterium necrophorum. Paediatr Radiol. 1984, 14 (1): 49-51. 10.1007/BF02386733.

    CAS  Article  Google Scholar 

  3. 3.

    Park D, Rezajooi K, Sabin I: Lemierre’s syndrome an unusual manifestation of spinal infection. J Bone Joint Surg, Br Vol. 2006, 88 (2): 261-262. 10.2106/JBJS.D.02932.

    CAS  Article  Google Scholar 

  4. 4.

    Saed S, Zafar U, Johnson LB: Fusobacterium causing concomitant liver and brain abscesses. Infect Dis Clin Pract. 2005, 13 (5): 265-267. 10.1097/01.idc.0000168477.65847.24.

    Article  Google Scholar 

  5. 5.

    Karkos PD, Asrani S, Karkos CD, Leong SC, Theochari EG, Alexopoulou EG, Assimakopoulos AD: Lemierre's syndrome: a systematic review. Laryngoscope. 2009, 119 (8): 1552-1559. 10.1002/lary.20542.

    Article  PubMed  Google Scholar 

  6. 6.

    Kujur R, Rao SM, Badwaik G, Paraswani R: Thrombosis associated with right internal jugular central venous catheters: A prospective observational study Indian. J Crit Care Med. 2012, 16 (1): 17-21.

    Google Scholar 

  7. 7.

    Van Rooden CJ, Tesselaar MET, Osanto S, Rosendaal FR, Huisman MV: Deep vein thrombosis associated with Central Venous Catheters; a review. J Thromb Haemost. 2005, 3: 2409-2419. 10.1111/j.1538-7836.2005.01398.x.

    Article  Google Scholar 

  8. 8.

    Lordick F, Hentrich M, Decker T, Hennig M, Pohlman H, Hartenstein R, Peschel C: Ultrasound screening for internal jugular vein thrombosis aids the detection of central venous catheter-related infections in patients with haemato-oncological diseases: a prospective observational study. Br J Haematol. 2003, 120 (6): 1073-1078. 10.1046/j.1365-2141.2003.04199.x.

    Article  PubMed  Google Scholar 

  9. 9.

    Gupta N, Kralovic SM, McGraw D: Lemierre syndrome: not so forgotten!. Am J Crit Care. 2014, 23 (2): 176-179. 10.4037/ajcc2014975.

    Article  PubMed  Google Scholar 

  10. 10.

    Marulasiddappa V, Tejesh CA: Lemierre’s syndrome presenting with septic shock Indian. J Crit Care Med. 2013, 17 (6): 382-384.

    Google Scholar 

  11. 11.

    Kim T, Choi JY: Lemierre syndrome with thrombosis of sigmoid sinus following dental extraction: a case report. J Korean Assoc Oral Maxillofac Surg. 2013, 39 (2): 85-89. 10.5125/jkaoms.2013.39.2.85.

    PubMed Central  Article  PubMed  Google Scholar 

  12. 12.

    Phua CK, Chadachan VM, Acharya R: Lemierre syndrome – should we anticoagulate? A case report and review of the literature. Int J Angiol. 2013, 22 (2): 137-142. 10.1055/s-0033-1336828.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  13. 13.

    Cherpillod Traschel J, Maestre LA, Gudinchet F: Imaging of Lemierre’s in children and young adults. Praxis. 2013, 102 (25): 1519-1527. 10.1024/1661-8157/a001476.

    Article  Google Scholar 

  14. 14.

    Moore C, Addison D, Wilson JM, Zeluff B: First case of fusobacterium necrophorum endocarditis to have presented after the 2nd decade of life. Tex Heart Inst J. 2013, 40 (4): 449-452.

    PubMed Central  PubMed  Google Scholar 

  15. 15.

    Dubois G, Damas F, Fraipont V: Clinical case of the month: an unusual sepsis. Rev Medi Liege. 2013, 68 (7–8): 387-390.

    CAS  Google Scholar 

  16. 16.

    Blessing K, Toepfner N, Kinzer S, Mollmann C, Serr A, Hufnagel M, Muller C, Kruger M, Ridder GJ, Berner R: Lemierre syndrome associated with 12th cranial nerve palsy – a case report and review. Int J Paediatr Otorhinolaryngol. 2013, 77 (9): 1585-1588. 10.1016/j.ijporl.2013.05.030.

    Article  Google Scholar 

  17. 17.

    Abhishek A, Sandeep S, Tarun P: Lemierre syndrome from a neck abscess due to methicillin resistant staphylococcus aureus. Brazillian J Infect Dis. 2013, 17 (4): 507-509. 10.1016/j.bjid.2012.11.010.

    Article  Google Scholar 

  18. 18.

    Righini CA, Karkas A, Tournaire R, N’Gouan JM, Schmerber S, Reyt E, Atallah I: Lemierre syndrome: a study of 11 cases and literature. Rev Head Neck. 2013, Online Publication: doi:10.1002/hed.23410

    Google Scholar 

  19. 19.

    DeGaffe GH, Murphy JR, Butler IJ, Shelburne J, Heresi GP: Severe narrowing of left cavernous carotid artery associated with Fusobacterium necrophorum infection. Anaerobe. 2013, 22: 118-120.

    Article  PubMed  Google Scholar 

  20. 20.

    Wahab D, Bichard J, Shah A, Mann B: Just a sore throat? Uncommon causes of significant respiratory disease. Br Med J Case Rep. 2013, Online Publication: doi:10.1136/bcr-2013-008739

    Google Scholar 

  21. 21.

    Paul SP, Beri R, Linney MJ: Lemierre’s syndrome: a sinister sore throat every clinician should remember Turkish. J Paediatr. 2012, 54 (5): 528-531.

    Google Scholar 

  22. 22.

    Ramos A, Berbari E, Huddleston P: Diagnosis and treatment of Fusobacterium nucleatum disciitis and vertebral osteomyelitis: a case report and review of the literature. Spine. 2013, 38 (2): 120-122. 10.1097/BRS.0b013e31827b4d61.

    Article  Google Scholar 

  23. 23.

    Lim AL, Pua KC: Lemierre syndrome medical. J Malays. 2012, 67 (3): 340-341.

    Google Scholar 

  24. 24.

    Tsai YJ, Lin YC, Harnnd DJ, Chiang RP, Wu HM: A Lemierre syndrome variant caused by Klebsiella pneumoniae. J Formosan Assoc. 2012, 111 (7): 403-405. 10.1016/j.jfma.2012.03.012.

    Article  Google Scholar 

  25. 25.

    Iwasaki T, Yamamoto T, Inoue K, Takaku K: A case of Lemierre’s syndrome in association with liver abscess without any other metastatic lesions. Intern Med. 2012, 51 (11): 1419-1423. 10.2169/internalmedicine.51.7364.

    Article  PubMed  Google Scholar 

  26. 26.

    Kuppalli K, Livorsi D, Talati NJ, Osborn M: Lemierre’s syndrome due to Fusobacterium necrophorum. Lancet Infect Dis. 2012, 12 (10): 808-815. 10.1016/S1473-3099(12)70089-0.

    Article  PubMed  Google Scholar 

  27. 27.

    Hsu YP, Tsai SH, Li LY: Isolated septic arthritis of the hip secondary to Fusobacterium necrophorum. Am J Med Sci. 2012, 343 (3): 262-264. 10.1097/MAJ.0b013e31823a76e6.

    Article  PubMed  Google Scholar 

  28. 28.

    Price K, Wilson L, Tsegaye M: A case of craniocervical abscess with sinus thrombosis in Lemierre’s syndrome. Br J Neurosurg. 2012, 26 (3): 426-428. 10.3109/02688697.2011.625062.

    Article  PubMed  Google Scholar 

  29. 29.

    Yamamoto E, Fukae T, Kawai Y, Kamio M, Fukumi S, Nakagawa M, Matsunaga K, Numata Y: Case of Fusobacterium necrophorum sepsis (Lemierre’s syndrome) with pulmonary septic emboli and liver abscess. Nihon Rinsho Meneki Gakkai Kaishi. 2011, 34 (5): 431-437. 10.2177/jsci.34.431.

    Article  PubMed  Google Scholar 

  30. 30.

    Huynh-Moynot S, Commandeur D, Deserts MD, Drouillard I, Leguen P, Ould-Ahmed M: Septic shock Fusobacterium necrophorum from gynaecological origin with complicated acute respiratory distress syndrome: a variant of Lemierre’s syndrome. Ann Clin Biol. 2011, 69 (2): 202-207.

    Google Scholar 

  31. 31.

    Kisser U, Gurkov R, Flatz W, Berghaus A, Reichel O: Lemierre syndrome: a case report. Am J Otolaryngol. 2012, 33 (1): 159-162. 10.1016/j.amjoto.2010.12.008.

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Courtin P, Toro A, Gazagnes M, Berrouba A, Gallardo M, Dembele A: Lemierre’s syndrome. French Ann Anaesthesiol. 2010, 29 (11): 799-802.

    CAS  Google Scholar 

  33. 33.

    Harris JD, Kaeding CC, Flanigan DC, Naylor AR, Ellis TJ: Severe musculoskeletal infection variant in Lemierre’s syndrome. Orthopaedics. 2010, 33 (10): 774-

    Google Scholar 

  34. 34.

    Rm C, Geiger P, Waites KB: Fusobacterium Necrophorum Bactaraemic tonsillitis: 2 cases and a review of the literature. Anaerobe. 2010, 16 (6): 626-628. 10.1016/j.anaerobe.2010.08.005.

    Article  Google Scholar 

  35. 35.

    Heimgartner B, Knecht U, Oestmann A: Fever and dysphagia of a young woman. Praxis. 2010, 99 (14): 859-862. 10.1024/1661-8157/a000189.

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Chacko EM, Krilov LR, Patten W, Lee PJ: Lemierre’s and Lemierre’s-like syndromes in association with infectios mononucleosis. J Laryngol Otol. 2010, 124 (12): 1257-1262. 10.1017/S0022215110001568.

    CAS  Article  PubMed  Google Scholar 

  37. 37.

    Teng HW, Chen CY, Chen HC, Chung WT, Lee WS: Fusobacterium septicaemia complicated by cerebral subdural and epidural empyema’s: a rare case of Lemierre syndrome. J Emerg Med. 2012, 43 (4): 671-673. 10.1016/j.jemermed.2010.04.033.

    Article  PubMed  Google Scholar 

  38. 38.

    Aouad R, Melkane A, Rassi S: Lemierre syndrome: unusual cause and presentation. Paediatr Emerg Care. 2010, 26 (5): 376-377. 10.1097/PEC.0b013e3181db235b.

    Article  Google Scholar 

  39. 39.

    Dirks J, Bowie D: Sore throat progressing to embolic sepsis: a case of Lemierre’s syndrome. Can Respir J. 2010, 17 (1): 20-22.

    Google Scholar 

  40. 40.

    Boldt BM, Nguyen D, Faga M, Caras W: Lemierre syndrome: from pharyngitis to fulminant Sepsis. BMJ Case Rep. 2010, Online Publication: doi:10.1136/bcr.06.2010.3121

    Google Scholar 

  41. 41.

    Braunbeck A, Geiger EV, Weber R, Maier M, Daecke W, Fiebig C, Marzi I: Phlegmon of the palm of the hand as initial manifestation of the Lemierre syndrome. UnfallChirurgica. 2010, 113 (2): 155-158. 10.1007/s00113-009-1710-2.

    CAS  Article  Google Scholar 

  42. 42.

    Ridgway JM, Parikhh DA, Wright R, Holden P, Armsrong W, Camilon F, Wong BJ: Lemierre syndrome: a paediatric case series and review of the literature. Am J Otolaryngol. 2010, 31 (1): 38-45. 10.1016/j.amjoto.2008.09.006.

    Article  PubMed  Google Scholar 

  43. 43.

    Gilbert JD, Warner S, Byard RW: Lemierre syndrome and unexpected death in childhood. J Forensic Leg Med. 2009, 16 (8): 476-481.

    Article  Google Scholar 

  44. 44.

    Ramadan HK: A vanishing disease can still happen. Emerg Med J. 2009, 26 (10): 749-10.1136/emj.2008.066282.

    CAS  Article  PubMed  Google Scholar 

  45. 45.

    Goyal MK, Kumar G, Burger R: necrobacillosis resulting in isolated carotid thrombosis and massive stroke: a unique Lemierre variant. J Neurol Sci. 2009, 287 (1–2): 108-110.

    Article  PubMed  Google Scholar 

  46. 46.

    Bilal M, Cleveland KO, Gelfand MS: Community-acquired methicillin-resistant staphylococcus aureus and Lemierre syndrome. Am J Med Sci. 2009, 338 (4): 326-327. 10.1097/MAJ.0b013e3181a9302b.

    Article  PubMed  Google Scholar 

  47. 47.

    Velagapudi P, Turagam M, Patel H, Yekkirala L: ‘A forgotten disease’: a case of Lemierre syndrome. Scientific World J. 2009, 20 (9): 331-332.

    Article  Google Scholar 

  48. 48.

    Ogugua C: Bilateral Lemierre syndrome secondary to periodontitis: a case report and review of the literature. J Brochol Intervent Pulmonol. 2009, 16 (2): 115-120. 10.1097/LBR.0b013e3181a05080.

    Article  Google Scholar 

  49. 49.

    Hile LM, Gibbons MD, Hile DC: Lemierre syndrome complicating otitis externa: case report and literature review. J Emerg Med. 2012, 42 (4): 77-80. 10.1016/j.jemermed.2009.02.014.

    Article  Google Scholar 

  50. 50.

    Gokce-Ceylan B, Yavuz L, Baydar CL, Tuz M, Eroglu F, Kiris I, Akcam FZ, Erdem B: Lemierre syndrome: a case of a rarely isolated micro-organism staphylococcus aureus. Med Sci Monit. 2009, 15 (3): 58-61.

    Google Scholar 

  51. 51.

    Alherabi A: A case of Lemierre syndrome. Ann Saudi Med. 2009, 29 (1): 58-60. 10.4103/0256-4947.51822.

    PubMed Central  Article  PubMed  Google Scholar 

  52. 52.

    Lu MD, Vasayada Z, Tanner C: Lemierre syndrome following oropharyngeal infection: a case series. J Am Board Fam Med. 2009, 22 (1): 79-83. 10.3122/jabfm.2009.01.070247.

    Article  PubMed  Google Scholar 

  53. 53.

    Abourazzak S, Zouagui A, Smaili L, Ouzaa H, Lamrani YM, Tizniti S, Elargam L, Chaouki S, Atmani S, Hida M: Lemierre syndrome: once seen it can never be mistaken. BMJ Case Rep. 2009, Online Publication: doi:10.1136/bcr.10.2008.1041

    Google Scholar 

  54. 54.

    O’Dwyer DN, Ryan S, O’Keefe T, Lyons J, Layelle L, McKone E: Lemierre’s syndrome. Ir J Med Sci. 2011, 180 (2): 556-557.

    Google Scholar 

  55. 55.

    Passalidou P, Berlioz M, Bailly C, Boutte P: Lemierre syndrome: a complication of an oropharyngeal infection. Arch Paediatr. 2008, 15 (12): 1775-1778. 10.1016/j.arcped.2008.09.009.

    CAS  Article  Google Scholar 

  56. 56.

    Aspesberro F, Siebler T, Van Nieuwenhuyse JP, Panosetti E, Berthet F: Lemierre syndrome in a 5-month-old male infant: case report and review of the paediatric literature paediatric. Crit Care Med. 2008, 9 (5): 35-37. 10.1097/PCC.0b013e31817319fa.

    Article  Google Scholar 

  57. 57.

    Seo YT, Kim MJ, Kim JH, Ha BW, Choi HS, Kim YT, Ham YH: Lemierre syndrome: a case of postanginal sepsis. Korean J Intern Med. 2007, 22 (3): 211-214. 10.3904/kjim.2007.22.3.211.

    PubMed Central  Article  PubMed  Google Scholar 

  58. 58.

    Juarez EI, Diaz CA, Aboul-Hons CS, Monner DA, Mari RA, Arranz OC, Piulachs CP, Lluch SJM, Cusco AS, Sieira GR: Lemierre syndrome associated with dental infections: report of one case and review of the literature. Med Oral Pathol Oral y Cirugica Buccal. 2007, 12 (5): 394-396.

    Google Scholar 

  59. 59.

    Syed MI, Baring D, Addidle M, Murray C, Adams C: Lemierre syndrome 2 cases and a review. Laryngoscopy. 2007, 117 (9): 1605-1610. 10.1097/MLG.0b013e318093ee0e.

    Article  Google Scholar 

  60. 60.

    Cheung WY, Bellas J: Case report: Lemierre syndrome presenting with fever and pharyngitis. Am Fam Physician. 2007, 75 (7): 979-980.

    PubMed  Google Scholar 

  61. 61.

    Waterman JA, Balbi HJ, Vaysman D, Ayres RA, Caronia CG: Lemierre syndrome: a case report. Paediatr Emerg Care. 2007, 23 (2): 103-105. 10.1097/PEC.0b013e3180302c0f.

    Article  Google Scholar 

  62. 62.

    Westhout F, Hasso A, Jalili M, Afghani B, Armstrong W, Nwagwu C, Ackerman LL: Lemierre syndrome complicated by cavernous sinus thrombosis with development of subdural empyema’s and internal carotid artery narrowing without cerebral infarction: a case report. J Neurosurg. 2007, 106 (1): 53-56.

    PubMed  Google Scholar 

  63. 63.

    Duong M, Wenger J: Lemierre syndrome. Paediatr Emerg Care. 2005, 21 (9): 589-593. 10.1097/01.pec.0000177198.91278.3e.

    Article  Google Scholar 

  64. 64.

    Nadkarni MD, Verchick J, O’Neill JC: Lemierre syndrome. J Emerg Med. 2005, 28 (3): 297-299. 10.1016/j.jemermed.2004.09.011.

    Article  PubMed  Google Scholar 

  65. 65.

    Sibaj K, Surasin F: Lemierre syndrome: a diagnosis to keep in mind. Rev Med Suisse Romande. 2004, 124 (11): 693-695.

    Google Scholar 

  66. 66.

    Hayashi M, Yamawaki I, Nakata J, Watanabe N, Ohkawa S: A case of Lemierre syndrome. Nihon Kokyuki Gakkai Zasshi. 2003, 41 (9): 651-654.

    PubMed  Google Scholar 

  67. 67.

    Klinge L, Vester U, Schaper J, Hoyer PF: Severe Fusobacteria infections (Lemierre syndrome) in 2 boys. Eur J Paediatr. 2002, 161 (11): 616-618. 10.1007/s00431-002-1026-5.

    Article  Google Scholar 

  68. 68.

    Lacaze O, Bocquel V, Fournel P, Emonot A: Lemierre syndrome: clinical and radiological characteristics of a rare disease. Revues de Maladies de Respiratoire. 2000, 17 (6): 1105-1106.

    CAS  Google Scholar 

  69. 69.

    Screaton NJ, Ravenel JG, Lehner PJ, Heitzman ER, Flower CD: Lemierre syndrome: forgotten but not extinct – report of 4 cases. Radiology. 1999, 213 (2): 369-374. 10.1148/radiology.213.2.r99nv09369.

    CAS  Article  PubMed  Google Scholar 

  70. 70.

    Bouton F, Cotils M, Genard M, Hubert C: Septic thrombophlebitis of the internal jugular vein and Lemierre syndrome. Revue Med de Bruxelles. 1998, 19 (1): 5-9.

    CAS  Google Scholar 

  71. 71.

    Beldman TF, Teunisse HA, Schouten TJ: Septic arthritis of the hip by Fusobacterium necrophorum after tonsillectomy: a form of Lemierre syndrome. Eur J Paediatr. 1997, 156 (11): 856-857. 10.1007/s004310050730.

    CAS  Article  Google Scholar 

  72. 72.

    Kubota M, Honda K, Izumi Y, Hanada N, Katagiri M, Yanase N, Tomita T: A case of Fusobacterium necroforum sepsis. Nihon Kyobu Shikkan Gakkai Zasshi. 1994, 32 (11): 1083-1087.

    CAS  PubMed  Google Scholar 

  73. 73.

    Blok WL, Meis JF, Gyssens IC, Gimbrere JS, Horrevorts AM: Postanginal sepsis caused by Fusobacterium necrophorum: Lemierre syndrome. Nederlands Tijdschr Geneeskds. 1993, 137 (20): 1013-1016.

    CAS  Google Scholar 

  74. 74.

    Weesner CL, Cisek JE: Lemierre syndrome: the forgotten disease. Ann Emerg Med. 1993, 22 (2): 256-258. 10.1016/S0196-0644(05)80216-1.

    CAS  Article  PubMed  Google Scholar 

  75. 75.

    Vogel LC, Boyer KM: Metastatic complications of Fusobacterium necrophorum sepsis: 2 cases of Lemierre’s postanginal septicaemia. Am J Dis Child. 1980, 134 (4): 356-358. 10.1001/archpedi.1980.04490010014005.

    CAS  Article  PubMed  Google Scholar 

  76. 76.

    Kamath SS, Mason K: ECMO in a patient with Fusobacterium sepsis: a case report and literature review. Ann Thorac Cardiovasc Surg. 2011, 17 (4): 397-399. 10.5761/atcs.cr.10.01587.

    Article  PubMed  Google Scholar 

  77. 77.

    Riordan T: Human infection with Fusobacterium necrophorum (Necrobacillosis), with a focus on Lemierre's syndrome. Clin Microbiol Rev. 2007, 20 (4): 622-659. 10.1128/CMR.00011-07.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

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Correspondence to Nicholas TE Bird.

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The author declares that they have no competing interest.

Authors’ contributions

NTEB: Recognised the uniqueness of presentation. Acquired background sources. Primary information analyst. Main writer of case. Read and approved the content of the case. PC: Additional background sources. Secondary writer. Read and approved the case content. DC: Additional background knowledge. Secondary writer. Proof read case. Edited for submission. BC: Additional background research and paper sourcing for literature review. RS: Image acquisition. Anonymised radiographic data. AH: Additional key source acquisition. Proof read and helped edit paper. MB: Consultant surgeon responsible for overall patient care and patient data. Read and approved manuscript. All authors read and approved the final manuscript.

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Bird, N.T., Cocker, D., Cullis, P. et al. Lemierre’s disease: a case with bilateral iliopsoas abscesses and a literature review. World J Emerg Surg 9, 38 (2014). https://doi.org/10.1186/1749-7922-9-38

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Keywords

  • Lemierre
  • Fusobacterium
  • Fusobacterium Necrophorum
  • Bilateral
  • Iliopsoas abscess