The challenges of a Lemierre’s syndrome in COVID-19 times

Authors

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20205077

Keywords:

Necrotizing fasciitis, Deep neck infection, Lemierre’s syndrome

Abstract

Lemierre’s syndrome is a type of necrotizing fasciitis of the head and neck that is an uncommon rapidly spreading infection involving the skin, subcutaneous tissue and the fascia leading to life-threatening complications like septicaemia, bone marrow suppression, disseminated intravascular coagulation and multi-organ failure. The management of this disease, especially in COVID-19 pandemic is a challenge as it is associated with high morbidity. A 46-year-old male presented to us with complaints of swelling in the neck with discoloration of skin in the neck and chest. Computed tomography (CT) scan of the neck revealed thrombosis of the right internal jugular vein (IJV) and diffuse abscesses on both sides of the neck. A high index of suspicion is required for the diagnosis of Lemierre’s syndrome in the absence of typical clinical features. The rapid, unpredictable dissemination of infection and occult thrombus within the IJV make both diagnosis and management a challenge especially, during COVID-19 times.

Author Biography

Vikram Kemmannu Bhat, Department of Otolaryngology, Head and Neck surgery, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India

Professor and Unit chief in ENT 

KIMS, Hubli, India

References

Hadjinicoloau AV, Philippou Y. Lemierre’s syndrome: A neglected disease with classical features. Case Rep Med. 2015;2015:846715.

Moore-Gillon J, Lee TH, Eykyn SJ, Phillips I. Necrobacillosis: A forgotten disease. BMJ. 1984;288(6429):1526-7.

Lemierre A. On certain septicemias due to anaerobic organisms. Lancet. 1936;1:7.

Noh HJ, Freitas CA, Souza Rde P, Simões JC, Kosugi EM. Lemierre syndrome: a rare complication of pharyngotonsillitis. Braz J Otorhinolaryngol. 2015;81(5):568-70.

Shires CB, Klug T, Shete M, Sebelik M. Multiplanar Computed Tomography Reconstruction to Diagnose Lemierre’s Syndrome. OTO open. 2020;4(3):2473974X20940692.

Ogunbayo GO, Adunse J, Olorunfemi O, Abdulsalam N. Lemierre’s Syndrome without Internal Jugular Vein Thrombophlebitis: A Diagnostic Conundrum. J Infect Dis Epidemiol. 2016;2:017.

Karkos PD, Asrani S, Karkos CD, Leong SC, Theochari EG, Alexopoulou TD et al. Lemierre's syndrome: a systematic review. Laryngoscope. 2009;119(8):1552-9.

Gore MR. Lemierre Syndrome: A Meta-analysis. Int Arch Otorhinolaryngol. 2020;24(3):379-85.

Schubert AD, Hotz MA, Caversaccio MD, Arnold A. Septic thrombosis of the internal jugular vein: Lemierre's syndrome revisited. Laryngoscope. 2015;125(4):863-8.

Downloads

Published

2020-11-24

Issue

Section

Case Reports