A Rare Case of Lemierre's Syndrome due to Veillonella Parvula: A Dangerous and Forgotten Complication of a Septic Condition.
Manuela MontatoreAntonio ZagariaFederica MasinoGiacomo FasciaMichele DebitontoGiuseppe GuglielmiPublished in: Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India (2024)
This clinical case presents an unusual case of Lemierre's syndrome (LS) in a young woman of 38-year-old. She arrived in the Emergency Department with a high fever and pharyngology resistant to antibiotic therapy with clarithromycin, ceftriaxone, and cortisone for two weeks. At the blood sampling, there is a marked leucocytosis, and the advice of the otolaryngologist is required given the strong pain in the throat. Due to the tonsillar abscess, a neck CT with a contrast medium is necessary for the otolaryngologist's opinion. The CT shows thrombosis of the jugular vein and left subclavian, with thickening of soft perivascular tissues; these findings suggest Lemierre's syndrome: a septic thrombophlebitis of the jugular vein that occurs as a complication of a peritonsillar abscess. The diagnostic process is then completed with a chest HR-CT, which reveals lung density and excavation areas suggesting tuberculosis. Blood culture reveals the presence of Veillonella Parvula (an anaerobic gram-negative coccus), sputum culture reveals the presence of some colonies of Enterobacter cloacae complex, real-time PCR examination on sputum reveals the presence of Streptococcus Pneumoniae and the borderline presence of rhinovirus. Microbiologists, after these results and neck and chest CT with a contrast agent, agree with the diagnosis of suspected LS at an early stage: a septic dissemination fortunately limited only to the neck and lungs region.
Keyphrases
- contrast enhanced
- rare case
- image quality
- dual energy
- computed tomography
- gram negative
- emergency department
- mycobacterium tuberculosis
- early stage
- acute kidney injury
- magnetic resonance imaging
- pulmonary tuberculosis
- case report
- magnetic resonance
- multidrug resistant
- positron emission tomography
- pulmonary embolism
- real time pcr
- chronic pain
- helicobacter pylori
- microbial community
- gene expression
- wastewater treatment
- ultrasound guided
- hepatitis c virus
- stem cells
- lymph node
- risk assessment
- preterm birth
- drug induced
- replacement therapy