A unique case of Lemierre’s syndrome status post blunt cervical trauma

Author:

Denesopolis John M12ORCID,Medicherla Singh Ratna C12,Shah Amit R34,Lyon Ross34,Chao Edward45,Hochsztein Jay G6,Rivera Aksim34

Affiliation:

1. Division of Vascular and Endovascular Surgery, Montefiore Medical Center, Bronx NY, USA

2. Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY, USA

3. Department of Cardiovascular and Thoracic Surgery, Jacobi Medical Center, Bronx, NY, USA

4. Department of Surgery, Jacobi Medical Center, Bronx, NY, USA

5. Department of Trauma Surgery and Surgical Critical Care, Jacobi Medical Center, Bronx, NY, USA

6. Department of Radiology, Jacobi Medical Center, Bronx, NY, USA

Abstract

Background Lemierre’s syndrome is a rare but potentially fatal condition. The course is characterized by acute tonsillopharyngitis, bacteremia, internal jugular vein thrombosis, and septic embolization. There have been some cases secondary to penetrating trauma to the neck. Literature review has yielded no cases secondary to blunt neck trauma in the absence of oropharyngeal injury. We aim to shed light on this unique cause of Lemierre’s syndrome, so as to raise the index of suspicion for clinicians working up patients with blunt cervical trauma. Methods We present a case of a 25-year-old male restrained driver who presented with left neck and shoulder pain with a superficial abrasion to the left neck from the seatbelt who was discharged same day by the Emergency Room physicians. He returned to the Emergency Department two days later with abdominal pain. As a part of his repeat evaluation, a set of blood cultures were sent and was sent home that day. The patient was called back to the hospital one day later as preliminary blood cultures were positive for Gram positive cocci and Gram negative anaerobes. Computerized tomography scan of the neck revealed extensive occlusive left internal jugular vein thrombosis and fluid collections concerning for abscesses, concerning for septic thrombophlebitis. The patient continued to decompensate, developing severe sepsis complicated by disseminated intravascular coagulation. Results The patient underwent a left neck exploration with en bloc resection of the left internal jugular vein, drainage of abscesses deep to the sternocleidomastoid, and washout/debridement of necrotic tissue. Direct laryngoscopy at the time of surgery revealed no injury to the aerodigestive tract. Wound cultures were consistent with blood cultures and grew Fusobacterium necrophorum, Staphylococcus epidermidis, and Methicillin-resistant staphylococcus aureus. The patient underwent two subsequent operative wound explorations without any evidence of residual infection. The patient was discharged home on postoperative day 13 on a course of antibiotics and aspirin. Conclusion This case illustrates the importance of diagnosis of Lemierre’s syndrome after an unconventional inciting event (blunt cervical trauma) and appropriate treatment.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,Radiology, Nuclear Medicine and imaging,General Medicine,Surgery

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