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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

(A) Initial venography shows impaired blood flow in the right internal jugular vein (IJV) and superior vena cava (SVC). (B) Follow-up venography reveals improved blood flow after catheter-directed thrombolysis and SVC stenting (arrowheads). (C) Computed tomography at 6 months after treatment shows resolution of the thrombosis and intact blood flow in both IJV and SVC (arrows).
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Figure 3: (A) Initial venography shows impaired blood flow in the right internal jugular vein (IJV) and superior vena cava (SVC). (B) Follow-up venography reveals improved blood flow after catheter-directed thrombolysis and SVC stenting (arrowheads). (C) Computed tomography at 6 months after treatment shows resolution of the thrombosis and intact blood flow in both IJV and SVC (arrows).

Mentions: Despite the intensive medical therapy, the swelling in the face and both arms progressed along with significant leukocytosis with a left shift. On day 8, an enhanced chest CT scan was performed for differential diagnosis, showing extensive occlusive thrombi within the bilateral internal jugular, subclavian and bracheocephalic veins and SVC with lung adenocarcinoma in the left apex and decreased metastatic lesions (Figure 2). CDT, aspiration thrombectomy and SVC endovascular stent placement were performed with 5,000 units of heparin and 500,000 units of urokinase and followed by the overnight infusion of 1,000,000 units of urokinase to relieve the patient's symptoms. Follow-up venography showed residual thrombi in right IJV, thus the repeated aspiration thrombectomy were performed. Final venography revealed the resolution of the thrombosis and intact blood flow in both IJV and SVC (Figure 3A, B). Swelling of the face and both upper arms, and hematology profile were improved 3 days after thrombolysis and the antibiotic and anticoagulation therapies were continued for additional 4 weeks. Recurrence and further complications were not observed over the next 6 months with prolonged anticoagulation therepy (rivaroxaban 20 mg/24 hr) (Figure 3C).


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)

(A) Initial venography shows impaired blood flow in the right internal jugular vein (IJV) and superior vena cava (SVC). (B) Follow-up venography reveals improved blood flow after catheter-directed thrombolysis and SVC stenting (arrowheads). (C) Computed tomography at 6 months after treatment shows resolution of the thrombosis and intact blood flow in both IJV and SVC (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: (A) Initial venography shows impaired blood flow in the right internal jugular vein (IJV) and superior vena cava (SVC). (B) Follow-up venography reveals improved blood flow after catheter-directed thrombolysis and SVC stenting (arrowheads). (C) Computed tomography at 6 months after treatment shows resolution of the thrombosis and intact blood flow in both IJV and SVC (arrows).
Mentions: Despite the intensive medical therapy, the swelling in the face and both arms progressed along with significant leukocytosis with a left shift. On day 8, an enhanced chest CT scan was performed for differential diagnosis, showing extensive occlusive thrombi within the bilateral internal jugular, subclavian and bracheocephalic veins and SVC with lung adenocarcinoma in the left apex and decreased metastatic lesions (Figure 2). CDT, aspiration thrombectomy and SVC endovascular stent placement were performed with 5,000 units of heparin and 500,000 units of urokinase and followed by the overnight infusion of 1,000,000 units of urokinase to relieve the patient's symptoms. Follow-up venography showed residual thrombi in right IJV, thus the repeated aspiration thrombectomy were performed. Final venography revealed the resolution of the thrombosis and intact blood flow in both IJV and SVC (Figure 3A, B). Swelling of the face and both upper arms, and hematology profile were improved 3 days after thrombolysis and the antibiotic and anticoagulation therapies were continued for additional 4 weeks. Recurrence and further complications were not observed over the next 6 months with prolonged anticoagulation therepy (rivaroxaban 20 mg/24 hr) (Figure 3C).

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