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Weekly Chest CasesArchive of Old Cases

Case No : 657 Date 2010-05-31

  • Courtesy of Mi-jin kang / Inje University Sanggye Paik Hospital
  • Age/Sex 14 / M
  • Chief ComplaintCough, blood-tinged sputum for 2 weeks
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Lemierre Syndrome
Radiologic Findings
Brief Review
Lemierre's Syndrome (or Lemierre's disease, also known as postanginal sepsis and human necrobacillosis) is a form of thrombophlebitis[1] usually caused by the bacterium Fusobacterium necrophorum, and occasionally by other members of the genus Fusobacterium (F. nucleatum, F. mortiferum and F. varium etc.) and usually affects young, healthy adults. Lemierre's syndrome develops most often after a sore throat caused by some bacterium of the Streptococcus genus, has created a peritonsillar abscess, a crater filled with pus and bacteria near the tonsils. Deep in the abscess, anaerobic bacteria (microbes that do not require oxygen) like Fusobacterium necrophorum can flourish. The bacteria penetrate from the abscess into the neighboring jugular vein in the neck and there they cause an infected clot (thrombosis) to form, from which bacteria are seeded throughout the body by the bloodstream (bacteremia). Pieces of the infected clot break off and travel to the lungs as emboli blocking branches of the pulmonary artery bringing the heart's blood to the lungs. This causes shortness of breath, chest pain and severe pneumonia. Fusobacteria are normal inhabitants of the oropharyngeal flora. This is a very rare disease with only approximately 159 cases in the last 100 years.[2]

Sepsis following from a throat infection was described by Scottmuller in 1918. However it was Andre Lemierre, in 1936, who published a series of 20 cases where throat infections were followed by identified anaerobic septicemia, of whom 18 patients died.[3]
-- From Wikipedia, the free encyclopedia
References
1. Lemierre syndrome at Dorland's Medical Dictionary
2. O'Brien Sr, WT, Lattin GE Jr, Thompson AK. "Lemierre syndrome: an all-but-forgotten disease". AJR 187;3;324.
3. a b c Lemierre A. "On certain septicemias due to anaerobic organisms". Lancet 1: 701?.
Keywords
Vascular, Vasculitis, Bacterial infection,

No. of Applicants : 128

▶ Correct Answer : 51/128,  39.8%
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - Osaka University , Japan Osamu Honda
  • - Department of Diagnostic Radiology, Chonbuk National University Hospital , Korea (South) Eun Jung Choi
  • - CHUV , Switzerland Philipp Rau
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Hospital M de Deus , Brazil Thiago Bento da Silva
  • - CHU NANCY , France, Metropolitan GREGORY LESANNE
  • - Samsung Medical Center , Korea (South) Jung Min Seo
  • - SMC , Korea (South) Yi Kyung Kim
  • - chp st martin , France Mariotte benoit
  • - CHU NANCY , France S. APTEL - A. RAYMOND
  • - University of British Columbia , Canada Amr Ajlan
  • - Assam Medical College , India Karunakaran M
  • - Seoul Veterans Hospital , Korea (South) Hye Sun Hwang
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - hospital de clinicas de porto alegre , Brazil ana zanardo
  • - , Korea (South) Cha Ik
  • - McGill University Health Center , Canada Alexandre Semionov
  • - CHU Grenoble , France Fabrice Bing
  • - CHUV , Switzerland ANNE-SOPHIE KNOEPFLI
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - HIA Legouest , France Alban Gervaise
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - CHRU lille , France manuel toledano
  • - Soonchunhyang university hospital, Bucheon , Korea (South) Hyelin Kim
  • - Shinchon Severance Hospital , Korea (South) Ho-Joon Lee
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - seoul national university hospital , Korea (South) Ijin Joo
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - royal melbourne hospital , Australia stefan heinze
  • - CH de la Ce Basque , France Paul ARDILOUZE
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - CHU Nancy , France, Metropolitan Guillaume LUX
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - IRSA , France jean-luc BIGOT
  • - Samsung medical center , Korea (South) Hyun Su Kim
  • - Kuang Tien General Hospital , Taiwan Seaharn Pan
  • - Radiologie Centrale CHU Saint Etienne , France Romain MALEZIEUX
  • - McGill University , Canada Sean Carr
  • - McGill University , Canada Ben Smith
  • - All India Institute of medical sciences , India Justin Moses
  • - Chonnam university hospital , Korea (South) Minyoung Jung
  • - Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
  • - PITTWATER RADIOLOGY , Australia Julie Arora
  • - PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Asan Medial center , Korea (South) Chae Lim
  • - Chonnam national university hospital , Korea (South) Jang-hyeon Song
  • - CNUH , Korea (South) Hyedoo Jung
▶ Correct Answer as Differential Diagnosis : 1/128,  0.8%
  • - radiologist, aditya imaging centre , India vivek patel
▶ Semi-Correct Answer : 31/128,  24.2%
  • - kfhu , Saudi Arabia hind alsaif
  • - SoonChunHyang univ. hospital , Korea (South) Kim Jae Hyun
  • - Sunchun university hospital, Bucheon , Korea (South) So young
  • - OSWAL CANCER HOSP. , India VISHAL GARG
  • - KMC,Manipal , India satish maddukuri
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OKUBO
  • - Doctors Hospital , Bahamas muneesh sharma
  • - Kangnam Sacred Heart Hospital , Korea (South) Jaewon Kim
  • - CHRU Lille , France guillaume lefebvre
  • - Teleradiology solutions , India harish bhambore
  • - care hospital , India Chary D
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Nonsan Hospital , Korea (South) Eun-Tae Park
  • - ottawa , Canada nishard abdeen
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Myongi , Korea (North) soon Moon
  • - University of Southern California , United States Alison Wilcox
  • - Apollo Gleneagles hosp kolkata , India SALIM PARVEZ
  • - All India Institute of Medical Sciences , India Jitesh Ahuja
  • - IRSA Rochefort , France Viviane Pages
  • - Medical insurance organisation , Egypt Mohamed Farouk
  • - Yonsei University College of Medicine, Shinchon Severance hospital , Korea (South) Young Joo Suh
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - NDMVP Nashik , India Imran Jindani
  • - jobless , France jean-baptiste Noel
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - NASA SCANS , India RAKESH BHATIA
  • - , Korea (South) Hun-cheol lim
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - medical , India anup kumar
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