Limits...
Severe Sepsis Associated with Lemierre's Syndrome: A Rare but Life-Threatening Disease.

Tawa A, Larmet R, Malledant Y, Seguin P - Case Rep Crit Care (2016)

Bottom Line: Fusobacterium necrophorum was found in blood cultures.Patient left the unit four days after his admission without any organ dysfunction.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, Anaesthesia and Critical Care Department, University Hospital of Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France.

ABSTRACT
Background. The incidence of Lemierre's syndrome has increased in the past decade. This posttonsillitis complication may be life threatening. Case Presentation. A 19-year-old patient was admitted to Surgical Intensive Care Unit of a French University Hospital for high fever, low blood pressure, and haemoptysis following a sore throat episode. Blood analysis revealed a thrombopenia, an acute renal failure, and an elevated lactate serum. Fusobacterium necrophorum was found in blood cultures. Computed tomography of the neck and lungs confirmed the diagnosis of Lemierre's syndrome: pleural effusions, bilateral lung infiltrates, and an internal jugular vein thrombosis. Fluid administration and antibiotic treatment were quickly initiated. Patient left the unit four days after his admission without any organ dysfunction. Conclusion. Lemierre's syndrome may lead to multiorgan dysfunction and should be rapidly identified.

No MeSH data available.


Related in: MedlinePlus

Left jugular vein thrombosis associated with thrombosis of collateral veins (white arrows in panels (a) and (b)) and cervicofacial cellulitis.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4835622&req=5

fig1: Left jugular vein thrombosis associated with thrombosis of collateral veins (white arrows in panels (a) and (b)) and cervicofacial cellulitis.

Mentions: Four days later, he was admitted to the Surgical Intensive Care Unit of a French University Hospital because of severe sepsis with persistent fever and asthenia. Physical examination revealed a high fever (39°6), a low blood pressure (78/40 mmHg) with diffuse mottles, and respiratory failure (SpO2 88% while breathing room air) associated with haemoptysis. The ear, nose, and throat examination was normal and a tender induration was found on the left and upper side of the neck. Laboratory test revealed a thrombopenia (14 G/L), a high white blood cell count (14.1 G/L), a moderate acute renal injury (creatinine of 97 µmol/L and urea of 11.5 mmol/L), and an elevated lactate serum of 1.8 mmol/L (normal value < 1.2 mmol/L). A chest and neck computed tomography (Figures 1 and 2) revealed a retropharyngeal abscess, an internal jugular vein thrombosis, bilateral lung infiltrates, and pleural effusions. Ceftriaxone associated with metronidazole and gentamicin was introduced right after blood cultures were drawn. Few hours later, severe sepsis regressed after consequent fluid administration and platelet transfusion. Only medical treatment was necessary since the abscess was too profound to reach. Fusobacterium necrophorum and Streptococcus constellatus were found in blood cultures. Initial antibiotic therapy was replaced by high doses of amoxicillin (8 g), clavulanate, and metronidazole. The patient left the unit for the Infectious Diseases Unit four days after admission. Anticoagulant treatment by heparin was initiated on the fifth day when thrombopenia was corrected. Oral anticoagulant was introduced secondarily. Apyrexia was obtained on the seventeenth day. Antibiotic therapy was maintained for three weeks.


Severe Sepsis Associated with Lemierre's Syndrome: A Rare but Life-Threatening Disease.

Tawa A, Larmet R, Malledant Y, Seguin P - Case Rep Crit Care (2016)

Left jugular vein thrombosis associated with thrombosis of collateral veins (white arrows in panels (a) and (b)) and cervicofacial cellulitis.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835622&req=5

fig1: Left jugular vein thrombosis associated with thrombosis of collateral veins (white arrows in panels (a) and (b)) and cervicofacial cellulitis.
Mentions: Four days later, he was admitted to the Surgical Intensive Care Unit of a French University Hospital because of severe sepsis with persistent fever and asthenia. Physical examination revealed a high fever (39°6), a low blood pressure (78/40 mmHg) with diffuse mottles, and respiratory failure (SpO2 88% while breathing room air) associated with haemoptysis. The ear, nose, and throat examination was normal and a tender induration was found on the left and upper side of the neck. Laboratory test revealed a thrombopenia (14 G/L), a high white blood cell count (14.1 G/L), a moderate acute renal injury (creatinine of 97 µmol/L and urea of 11.5 mmol/L), and an elevated lactate serum of 1.8 mmol/L (normal value < 1.2 mmol/L). A chest and neck computed tomography (Figures 1 and 2) revealed a retropharyngeal abscess, an internal jugular vein thrombosis, bilateral lung infiltrates, and pleural effusions. Ceftriaxone associated with metronidazole and gentamicin was introduced right after blood cultures were drawn. Few hours later, severe sepsis regressed after consequent fluid administration and platelet transfusion. Only medical treatment was necessary since the abscess was too profound to reach. Fusobacterium necrophorum and Streptococcus constellatus were found in blood cultures. Initial antibiotic therapy was replaced by high doses of amoxicillin (8 g), clavulanate, and metronidazole. The patient left the unit for the Infectious Diseases Unit four days after admission. Anticoagulant treatment by heparin was initiated on the fifth day when thrombopenia was corrected. Oral anticoagulant was introduced secondarily. Apyrexia was obtained on the seventeenth day. Antibiotic therapy was maintained for three weeks.

Bottom Line: Fusobacterium necrophorum was found in blood cultures.Patient left the unit four days after his admission without any organ dysfunction.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, Anaesthesia and Critical Care Department, University Hospital of Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France.

ABSTRACT
Background. The incidence of Lemierre's syndrome has increased in the past decade. This posttonsillitis complication may be life threatening. Case Presentation. A 19-year-old patient was admitted to Surgical Intensive Care Unit of a French University Hospital for high fever, low blood pressure, and haemoptysis following a sore throat episode. Blood analysis revealed a thrombopenia, an acute renal failure, and an elevated lactate serum. Fusobacterium necrophorum was found in blood cultures. Computed tomography of the neck and lungs confirmed the diagnosis of Lemierre's syndrome: pleural effusions, bilateral lung infiltrates, and an internal jugular vein thrombosis. Fluid administration and antibiotic treatment were quickly initiated. Patient left the unit four days after his admission without any organ dysfunction. Conclusion. Lemierre's syndrome may lead to multiorgan dysfunction and should be rapidly identified.

No MeSH data available.


Related in: MedlinePlus