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Weekly Chest CasesArchive of Old Cases

Case No : 419 Date 2005-11-07

  • Courtesy of Yon Mi Sung, MD / Samsung Medical Center, Sungkyunkwan University
  • Age/Sex 31 / F
  • Chief ComplaintSore throat, dry cough and fever for one week
  • Figure 1
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Diagnosis With Brief Discussion

Diagnosis
Lemierre Syndrome & Septic Pulmonary Embolism
Radiologic Findings
CT of the chest demonstrating multiple nodules, some of which are cavitated in a 31-year-old woman with Lemierre syndrome and septic pulmonary embolism. Bilateral pleural effusions are also present. CT of the neck demonstrating thrombosis of the internal jugular vein.

In this case, b-hemolytic streptococcus Group C was isolated from blood culture. The patient had a rapid response to IV antibiotics
Brief Review
Lemierre syndrome is an uncommon septic thrombophlebitis of the internal jugular vein. Most of the patients affected with this illness are adolescents or young adults in whom the inciting infection is tonsillopharyngitis, odontogenic infection, mastoiditis, or sinusitis. The usual cause is Fusobacterium necrophorum, but Streptococcus, Bacteroides, Peptostreptococcus, and Eikenella are also causes.

Extension of the infection to the adjacent lateral pharyngeal tissue containing the internal jugular vein results in the characteristic manifestations. Vascular involvement is followed by hematogenous spread to other organs, most commonly the lungs, causing metastatic abscesses. Pulmonary involvement in Lemierre syndrome has been reported in up to 97% of cases and has included septic pulmonary embolism with lung abscesses, pleural effusion, empyema, and pneumothorax.
References
1. Cook RJ, Ashton RW, Aughenbaugh GL, Ryu JH. Septic pulmonary embolism: presenting features and clinical course of 14 patients. Chest 2005;128:162-166

2. Kristensen LH, Prag J. Human necrobacillosis, with emphasis on Lemierre’s syndrome. Clin Infect Dis 2000;31:524-532

3. Liu AC, Argent JD. Necrobacillosis: a resurgence? Clin Radiol 2002;57:332-338
Keywords
Vascular, Embolic, Thromboembolic, Bacterial infection,

No. of Applicants : 42

▶ Correct Answer : 23/42,  54.8%
  • - Marien Hospital, Gemany Davis Chiramel
  • - Ev. Krkhs. Hubertus, Berlin, Germany Michael Weber
  • - Pgimer, Chandigarh, India Ashish Gupta
  • - Riverside Radiology Associates, Columbus, Ohio, USA Sumit Seth
  • - CHRA, Annecy France Bing Fabrice
  • - Maiminides Medical Center, New York, USA Naomi Twersky
  • - University of Miami, Jackson Memorial Hospital, USA Hermes Velasquez
  • - University of Ulsan, Asan Medical Center, Korea Ji Yeon Kim
  • - ASL Bologna, Maggiore Hospital, Bologna, Italy Marcellino Burzi
  • - Ross University, Porsmouth, Dominica Charles Ambelang
  • - CHU Grenoble, France Mathieu Rodiere
  • - Annecy Hospital, France Gilles Genin
  • - Ohio State University Medical Center, Columbus, USA Hari Charan P. Reddy
  • - Ping-Tung Christian Hospital , Taiwan Chi-Kuei Hsu
  • - Hanyang University Hospital, Seoul, Korea Yo Won Choi
  • - Annemasse, Polyclinique de Savoie, France Gay-Depassier
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
  • - Cabinet de Radiologie Guiton, La Rochelle, France Jean-Luc Bigot
  • - Seoul National University Hospital, Korea Eun Ju Chun
  • - Incheon Sarang Hospital, Incheon, Korea Jung Hee Kim
  • - China Medical University Hospital,Taiwan Jun-Jun Yeh
  • - Kosin University Gospel Hospitalm Busan, Korea Mi Hee Jung
  • - Hangang SacredHeart Hospital, Korea Eil Seong Lee
▶ Semi-Correct Answer : 11/42,  26.2%
  • - Yonsei University Hospital, Korea Eun Hye Yoo
  • - Busan National UniversityHospital, Korea Su-mi Shin
  • - Al Swaidaa National Hospital, Syria Marwan Al Chami
  • - SSGH, Vadodara, India Sushil Mansingani
  • - Homs National Hospital, Homs, Syria Rami Abou Zalaf
  • - Gwangmyoung Sungae Hospital, Korea Jiyong Rhee
  • - Max Hospital, New Delhi, India Vickrant Malhotra
  • - Ultracare Hospital, Coimbatore, India Debabrata Das
  • - Radiologie Guiton, La Rochelle, France Denis Chabassiere
  • - Monaldi Hospital, Naples, Italy Gaetano Rea
  • - Max Hospital, New Delhi, India Anurag Jain
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