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(Research Associate, Yale University, School of Medicine, New Haven CT, USA)
Med Sci Case Rep 2014; 1:39-42
Lemierre’s syndrome is usually caused by an acute infection with Fusobacterium necrophorum with secondary septic thrombophlebitis of the internal jugular vein and frequent metastatic infections.
Case Report: We report a case of Lemierre’s in a 25-year-old intravenous drug user. The patient presented with fever, chills, shortness of breath, and an inflamed neck. Duplex ultrasound showed right subclavian and internal jugular deep venous thrombosis. The patient developed numerous cavitary lesions in the lungs as a result of septic micro-embolism of the deep vein thrombus. In the first few days, respiratory distress necessitated supplemental oxygen therapy. The patient was admitted to the Intensive Care Unit (ICU). Blood culture grew Streptococcus B-hemolytic group C and F. necrophorum. Antibiotic treatment with Clindamycin and anti-coagulation with Warfarin were initiated. Symptoms gradually resolved and the patient was discharged after 15 days. This case was unusual in that an unsterile needle rather than the typical oropharyngeal cavity was the primary source of the infection and there was no connection between oral flora and this needle.
Conclusions: This case proves the fact that skin can serve as the source of F. necrophorum in Lemierre’s syndrome; therefore, it is important to consider this syndrome in an intravenous drug user that complains of inflammation at the site of injection. This clinical suspicion leads to earlier institution of therapy and prevents catastrophic complications like septic emboli, sepsis, and resultant organ failure.
Keywords: drug users, Fusobacterium necrophorum, Lemierre Syndrome, Pulmonary Embolism, Streptococcal Infections, Thrombophlebitis