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2009 ; 9
(ä): 331-2
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"A forgotten disease": a case of Lemierre syndrome
#MMPMID19468652
Velagapudi P
; Turagam M
; Are C
; Patel H
; Yekkirala L
ScientificWorldJournal
2009[May]; 9
(ä): 331-2
PMID19468652
show ga
Lemierre's syndrome is a rare but a life threatening condition which affects
young healthy individuals, was first described by Dr.Andre Lemierre in 1936.
Incidence rates are between 0.6 and 2.3 per million population. It is found more
commonly in males, with a male to female ratio of approximately 2:1. Its
pathogenesis consists of the development of infectious thrombophlebitis in the
internal jugular vein or one of its branches caused by a focal sepsis, mostly
localized in the oropharynx, leading to generalized multiorgan metastatic
infections, generally to the lung. This computerized tomography (CT) neck with
intravenous contrast is from a 24 year old female who presented with a two day
history of fever, hypotension and respiratory failure. The physical exam was
positive for diminished breath sounds bilaterally on lung exam. Complete blood
count revealed a leukocytosis of 16,200 u/L with 70% neutrophils and 9% bands,
hemoglobin of 13.4mg/dl and severe thrombocytopenia with a platelet count of
34,000 u/L; comprehensive metabolic panel revealed sodium 140mmol/L, potassium
2.9mmol/L, bicarbonate 26mmol/L, blood urea nitrogen (BUN) 16mg/dl, creatinine
0.8mg/dl, calcium 7.2 mg/dl, albumin 2.4g/dl, total bilurubin 3.1mg/dl, AST 81
U/L, ALK 101 U/L, ALT 35U/L. CT chest revealed multiple cavitary opacities in
both lungs. Blood cultures were positive for Fusobacterium necrophorum. CT scan
neck showed a filling defect of the right internal jugular vein consistent with a
thrombus and multiple enlarged cervical lymph nodes. Treatment is medical with
intravenous antibiotics and anticoagulation. References: 1. Carlson ER, Bergamo
DF, Coccia CT. Lemierre's syndrome: two cases of a forgotten disease. J Oral
Maxillofac Surg 1994; 52:74-78. 2. Moore-Gillon J, Lee TH, Eykyn SJ, Phillips I.
Necrobacillosis: a forgotten disease. BMJ 1984;288:1526-1527. 3. Jones C, Siva
TM, Seymour FK, O'Reilly BJ. Lemierre's syndrome presenting with peritonsillar
abscess and VIth cranial nerve palsy. J Laryngol Otol 2006;120:502-504 4.
Mohammed Iqbal Syed et al. Lemierre Syndrome: Two Cases and a Review.
Laryngoscope, 117:1605-1610, 2007 5. Vohra A, Saiz E, Ratzan KR. A young woman
with a sore throat, septicaemia, and respiratory failure. Lancet 1997; 350:928.
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