Presentations 2020: OMFS

410 - Suspected malignancy and unusual pathology in a severe case of Lemierre's syndrome

G Aruede S Ananth S Mustafa
Presented by: Glenda Aruede
Prince Charles Hospital

Introduction Lemierre’s syndrome, although rare, is a potentially fatal condition, usually caused by the anaerobic bacterium, Fusobacterium necrophorum. It is characterised by a primary oropharyngeal infection, with septic thrombophlebitis, clinical or radiographic evidence of internal jugular vein thrombosis and at least one metastatic focus. This case presents a previously healthy 59-year-old female, who had a three week history of sore throat and difficulty swallowing, later diagnosed as Lemierre’s disease. Methods Her observations on admission were a temperature of 38.6 degrees Celsius, pulse rate of 133bpm, respiratory rate of 17/minute, blood pressure of 73/42 mm Hg and 95% oxygen saturation on air. Her blood tests revealed an acute kidney alert and an elevated white cell count. She was admitted and treated for severe sepsis. Blood cultures taken were positive for Streptococcus constellatus and Dialister pneumosintes. A CT scan was performed which showed a 3 cm left level IV low-density suspected mass or necrotic node. There were multiple pulmonary nodules, at least one of which appeared necrotic, raising suspicion for metastases. On further review of the scan, a filling defect in the left internal jugular vein consistent with a thrombus was highlighted. Thw conclusive diagnosis was reached: Lemierre’s syndrome with septic pulmonary emboli. Results The patient was treated with intravenous benzylpenicillin, clindamycin and metronidazole in conjunction with daily enoxaparin. 16 days after admission the patient stopped spiking temperatures. After a further week of antibiotics, the she was fit for discharge on co-amoxiclav, metronidazole and enoxaparin for 6 weeks. At her review appointment 1 month after discharge, she had made a good recovery. Conclusion Dialister pneumosintes although uncommon, can be associated with Lemierre's disease as demonstrated in this case. Prompt diagnosis and targeted antibiotic treatment is important in cases of Lemierre’s disease.
Consent Statement: Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient/parent/guardian. A copy of the consent form is available for review by the the meeting organisers..

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