바로가기메뉴

본문 바로가기 주메뉴 바로가기

Extensive Bilateral Lemierre Syndrome due to Methicillin-Resistant Staphylococcus epidermidis in a Patient with Lung Adenocarcinoma

Tuberculosis & Respiratory Diseases / Tuberculosis & Respiratory Diseases,
2015, v.78 no.3, pp.289-292





  • Downloaded
  • Viewed

Abstract

Lemierre syndrome (LS) is a septic thrombophlebitis of the internal jugular vein (IJV) following an oropharyngeal infection. LS is commonly caused by normal anaerobic flora and treated with appropriate antibiotics and anticoagulation therapy. Although the incidence of disease is very rare, 15% cases of LS are fatal even in the antibiotic era because of disseminated septic thromboemboli. We reported a case of extensive bilateral LS due to methicillin-resistant Staphylococcus epidermidis in a 63-year-old female with lung adenocarcinoma. Initial examination revealed a retropharyngeal abscess; hence, intravenous ceftriaxone and steroid were initiated empirically. However, pulmonary thromboembolism developed and methicillin-resistant S. epidermidis was identified in the bacterial culture. Despite intensive antibiotic and anticoagulation therapies, extensive septic thrombophlebitis involving the bilateral IJV and superior vena cava developed. Adjunctive catheter-directed thrombolysis and superior vena cava stenting were performed and the patient received antibiotic therapy for an additional 4 weeks, resulting in complete recovery.

keywords
Lemierre Syndrome, Lung Adenocarcinoma, Methicillin Resistance, Staphylococcus epidermidis

Reference

1.

1. Lamierre A. (1936), On certain septicaemias due to anaerobic organisms. Lancet, 227,701-3.

2.

2. Kuppalli K., Livorsi D., Talati NJ., Osborn M. (2012), Lemierre’s syndrome due to Fusobacterium necrophorum . Lancet Infect Dis, 12,808-15.

3.

3. Riordan T. (2007), Human infection with Fusobacterium necrophorum (Necrobacillosis), with a focus on Lemierre’s syndrome. Clin Microbiol Rev, 20,622-59.

4.

4. Chanin JM., Marcos LA., Thompson BM., Yusen RD., Dunne WM Jr., Warren DK. (2011), Methicillin-resistant Staphylococcus aureus USA300 clone as a cause of Lemierre’s syndrome. J Clin Microbiol, 49,2063-6.

5.

5. Riordan T., Wilson M. (2004), Lemierre’s syndrome: more than a historical curiosa. Postgrad Med J, 80,328-34.

6.

6. Costa AR., Henriques M., Oliveira R., Azeredo J. (2009), The role of polysaccharide intercellular adhesin (PIA) in Staphylococcus epidermidis adhesion to host tissues and subsequent antibiotic tolerance. Eur J Clin Microbiol Infect Dis, 28,623-9.

7.

7. Righini CA., Karkas A., Tourniaire R., N’Gouan JM., Schmerber S., Reyt E. (2014), Lemierre syndrome: study of 11 cases and literature review. Head Neck, 36,1044-51.

8.

8. Blom JW., Osanto S., Rosendaal FR. (2004), The risk of a venous thrombotic event in lung cancer patients: higher risk for adenocarcinoma than squamous cell carcinoma. J Thromb Haemost, 2,1760-5.

9.

9. Bick RL. (2003), Cancer-associated thrombosis. N Engl J Med, 349,109-11.

10.

10. Varki A. (2007), Trousseau’s syndrome: multiple definitions and multiple mechanisms. Blood, 110,1723-9.

11.

11. McGouran D., Keene A., Walklin R., Carter J. (2013), A complex case of bilateral Lemierre syndrome with suggestions on anticoagulation management. Intern Med J, 43,728-30.

12.

12. Bach MC., Roediger JH., Rinder HM. (1988), Septic anaerobic jugular phlebitis with pulmonary embolism: problems in management. Rev Infect Dis, 10,424-7.

Tuberculosis & Respiratory Diseases