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Extensive Bilateral Lemierre Syndrome due to Methicillin-Resistant Staphylococcus epidermidis in a Patient with Lung Adenocarcinoma.

Choi BM, Son SW, Park CK, Lee SH, Yoon HK - Tuberc Respir Dis (Seoul) (2015)

Bottom Line: Initial examination revealed a retropharyngeal abscess; hence, intravenous ceftriaxone and steroid were initiated empirically.However, pulmonary thromboembolism developed and methicillin-resistant S. epidermidis was identified in the bacterial culture.Adjunctive catheter-directed thrombolysis and superior vena cava stenting were performed and the patient received antibiotic therapy for an additional 4 weeks, resulting in complete recovery.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea.

ABSTRACT
Lemierre syndrome (LS) is a septic thrombophlebitis of the internal jugular vein (IJV) following an oropharyngeal infection. LS is commonly caused by normal anaerobic flora and treated with appropriate antibiotics and anticoagulation therapy. Although the incidence of disease is very rare, 15% cases of LS are fatal even in the antibiotic era because of disseminated septic thromboemboli. We reported a case of extensive bilateral LS due to methicillin-resistant Staphylococcus epidermidis in a 63-year-old female with lung adenocarcinoma. Initial examination revealed a retropharyngeal abscess; hence, intravenous ceftriaxone and steroid were initiated empirically. However, pulmonary thromboembolism developed and methicillin-resistant S. epidermidis was identified in the bacterial culture. Despite intensive antibiotic and anticoagulation therapies, extensive septic thrombophlebitis involving the bilateral IJV and superior vena cava developed. Adjunctive catheter-directed thrombolysis and superior vena cava stenting were performed and the patient received antibiotic therapy for an additional 4 weeks, resulting in complete recovery.

No MeSH data available.


Related in: MedlinePlus

Sagittal images from an initial contrast-enhanced neck computed tomography scan show a retropharyngeal abscess (arrowheads).
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Figure 1: Sagittal images from an initial contrast-enhanced neck computed tomography scan show a retropharyngeal abscess (arrowheads).

Mentions: A computed tomography (CT) scan of the neck revealed a retropharyngeal abscess (Figure 1) and small amount of bilateral pleural effusion. Intravenous ceftriaxone, clindamycin and methylprednisolone (100 mg/12 hr) were initiated empirically after blood cultures. Four days after treatment, dysphagia and facial swelling were not improved and the swelling in both arms and pain to the suprasternal and left supraclavicular regions were additionally developed. Inflammatory changes in mediastinum, pulmonary thromboembolism in the interlobar pulmonary arteries and segmental atelectasis in the right lower lobe were detected using an CT pulmonary angiogram. A repeated laboratory test revealed elevated D-dimer, fibrinogen, and fibrin degradation product levels and methicillinresistant S. epidermidis was identified in the bacterial cultures from the peripheral blood. Anticoagulation therapy was initiated with enoxaparin (60 mg/12 hr) and warfarin (5 mg/day) and antibiotics were changed to intravenous vancomycin, piperacillin/tazobactam and clindamycin for suspected pulmonary thromboembolism and mediastinitis. Follow-up neck CT (day 7) revealed low density materials filling both IJV and SVC.


Extensive Bilateral Lemierre Syndrome due to Methicillin-Resistant Staphylococcus epidermidis in a Patient with Lung Adenocarcinoma.

Choi BM, Son SW, Park CK, Lee SH, Yoon HK - Tuberc Respir Dis (Seoul) (2015)

Sagittal images from an initial contrast-enhanced neck computed tomography scan show a retropharyngeal abscess (arrowheads).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499602&req=5

Figure 1: Sagittal images from an initial contrast-enhanced neck computed tomography scan show a retropharyngeal abscess (arrowheads).
Mentions: A computed tomography (CT) scan of the neck revealed a retropharyngeal abscess (Figure 1) and small amount of bilateral pleural effusion. Intravenous ceftriaxone, clindamycin and methylprednisolone (100 mg/12 hr) were initiated empirically after blood cultures. Four days after treatment, dysphagia and facial swelling were not improved and the swelling in both arms and pain to the suprasternal and left supraclavicular regions were additionally developed. Inflammatory changes in mediastinum, pulmonary thromboembolism in the interlobar pulmonary arteries and segmental atelectasis in the right lower lobe were detected using an CT pulmonary angiogram. A repeated laboratory test revealed elevated D-dimer, fibrinogen, and fibrin degradation product levels and methicillinresistant S. epidermidis was identified in the bacterial cultures from the peripheral blood. Anticoagulation therapy was initiated with enoxaparin (60 mg/12 hr) and warfarin (5 mg/day) and antibiotics were changed to intravenous vancomycin, piperacillin/tazobactam and clindamycin for suspected pulmonary thromboembolism and mediastinitis. Follow-up neck CT (day 7) revealed low density materials filling both IJV and SVC.

Bottom Line: Initial examination revealed a retropharyngeal abscess; hence, intravenous ceftriaxone and steroid were initiated empirically.However, pulmonary thromboembolism developed and methicillin-resistant S. epidermidis was identified in the bacterial culture.Adjunctive catheter-directed thrombolysis and superior vena cava stenting were performed and the patient received antibiotic therapy for an additional 4 weeks, resulting in complete recovery.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea.

ABSTRACT
Lemierre syndrome (LS) is a septic thrombophlebitis of the internal jugular vein (IJV) following an oropharyngeal infection. LS is commonly caused by normal anaerobic flora and treated with appropriate antibiotics and anticoagulation therapy. Although the incidence of disease is very rare, 15% cases of LS are fatal even in the antibiotic era because of disseminated septic thromboemboli. We reported a case of extensive bilateral LS due to methicillin-resistant Staphylococcus epidermidis in a 63-year-old female with lung adenocarcinoma. Initial examination revealed a retropharyngeal abscess; hence, intravenous ceftriaxone and steroid were initiated empirically. However, pulmonary thromboembolism developed and methicillin-resistant S. epidermidis was identified in the bacterial culture. Despite intensive antibiotic and anticoagulation therapies, extensive septic thrombophlebitis involving the bilateral IJV and superior vena cava developed. Adjunctive catheter-directed thrombolysis and superior vena cava stenting were performed and the patient received antibiotic therapy for an additional 4 weeks, resulting in complete recovery.

No MeSH data available.


Related in: MedlinePlus