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• W2980607936 abstract "SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Lemierre’s syndrome (LS) is a rare and life-threatening disease characterized by infectious thrombophlebitis of the internal jugular vein, usually as a complication of oropharyngeal infection. The most common culprits are Fusobacterium species. This case describes the clinical course of a patient with Lemierre’s syndrome caused by methicillin-resistant staphylococcus aureus (MRSA) in the absence of an oropharyngeal infectious focus. CASE PRESENTATION: A 63-year-old male with history of recurrent back abscesses presented with left neck pain 11 days after his second surgery for abscess drainage. He was found to be tachycardic, tachypneic, with worsening neck pain and left upper extremity swelling. Computed Tomography (CT) imaging of the neck revealed a large, multiseptated, complex fluid collection involving the left paraspinal muscles and obliterating the adjacent left internal jugular vein, with associated thrombus. The patient underwent emergent surgical neck exploration with removal of 25 mL of purulent fluid. He was treated with vancomycin, cefepime and metronidazole. Further imaging revealed multiple bilateral pulmonary septic emboli. Ultimately, microbiological data yielded MRSA. Unfortunately, the patient went on to develop a fixed and dilated left pupil and diffuse motor weakness that rapidly progressed to quadriplegia. Magnetic resonance imaging revealed evidence of osteomyelitis at the C3-C4 level and associated spinal cord infarct. An ultrasonographic sniff test was performed and showed minimal excursion of the diaphragm consistent with the bilateral phrenic nerve paralysis. Neurosurgical consultation was obtained, with recommendations for medical management only. Tracheostomy and PEG tube were established. With time, he was able to recover eye movements, but remained quadriplegic. DISCUSSION: LS is commonly referred to as “the forgotten disease” which alludes to the drop in incidence with early use of broad-spectrum antibiotics in the treatment of sepsis. Typically, the syndrome is associated with Fusobacterium species (up to 63% [2]), and an oropharyngeal source of infection. However, other organisms have been reported, with up to 4% of cases due to MRSA [2]. A delay in diagnosis and treatment initiation may result in devastating complications related to embolic phenomena. Most cases report septic pulmonary emboli, but embolization to liver, spleen, joints, heart have also been described [1,2,3]. In our case, the infection spread to multiple vertebrae, leading to osteomyelitis and compression of the spinal cord. CONCLUSIONS: A thorough history and exam coupled with a high index of suspicion for LS should prompt early antibiotic administration. Appropriate antibiotic selection should include coverage of both fusiobacterium and MRSA, as clinical deterioration can be both swift and devastating. Reference #1: “The long shadow of Lemierre’s syndrome,”, Osowicki et al., J. of Inf. 2017; 74: 47-53 Reference #2: “Lemierre’s syndrome: current perspectives on diagnosis and management,” Katrine Johannesen, Ufffe Bodtger, Infection and Drug Resistance 2016; 9: 221-227 Reference #3: “Lemierre’s syndrome: Diagnosis, exploration, treatment,” H. Mesrar et al., La Revue de Medecine Interne 2018, vol. 39, issue 5: 339-345 DISCLOSURES: No relevant relationships by Marina Johnston, source=Web Response No relevant relationships by Mit Patel, source=Web Response Speaker/Speaker's Bureau relationship with Genentech Please note: $5001 - $20000 Added 03/15/2019 by Joshua Sill, source=Web Response, value=Honoraria" @default.
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• W2980607936 date "2019-10-01" @default.
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• W2980607936 title "THE FORGOTTEN FRENCHMAN: A CASE OF MRSA-ASSOCIATED LEMIERRE'S SYNDROME" @default.
• W2980607936 doi "https://doi.org/10.1016/j.chest.2019.08.2160" @default.
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