RARE BUT NOT FORGOTTEN: A CASE OF ATYPICAL BACTERIA SPECIES IN LEMIERRE'S SYNDROME

SESSION TITLE: Pulmonary Manifestations of Systemic Disease Case Report Posters 14 SESSION TYPE: Case Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am INTRODUCTION: Lemierre's syndrome is a rare but potentially fatal condition characterized by internal jugular venous thrombosis and anaerobic septicemia following a recent oropharyngeal infection caused by Fusobacterium necrophorum. While the disease has become less common in the antibiotic era, mortality rates were as high as 90% before the availability of antibiotics. In this case report, we describe a patient with an atypical bacterial species identified in association with Lemierre's syndrome. CASE PRESENTATION: We present the case of a 38-year-old Chinese man with no significant medical history who presented with odynophagia, fever, chills, and diaphoresis for two days. His symptoms worsened progressively, with tenderness on palpation of his left neck. The patient reported a recent dental procedure four months prior for dental care. He denied trauma, alcohol use, tobacco use, and recreational drug use. On admission, he was afebrile and in no acute distress with good oxygenation, but was tachycardic. Physical exam revealed limited range of motion of the neck due to pain, left submandibular tenderness to palpation, bilateral tonsillar edema with exudates, and a leftward deviated uvula. Labs were significant for leukocytosis with neutrophilic predominance. CT imaging of the neck with contrast revealed enlargement of the left palatine tonsil and a small focus of hypodensity in the tonsil. CT chest without contrast revealed cavitary lesions in the right lower lobe. A carotid doppler revealed non-occlusive DVT in the left jugular vein. Blood culture grew Fusobacterium nucleatum and Clostridium clostridioforme. The combination of physical exam findings, imaging, and blood culture results confirmed a diagnosis of Lemierre's syndrome. DISCUSSION: This case is notable for the presence of atypical bacterial species in association with Lemierre's syndrome. While up to 71.2% of reported cases are due to Fusobacterium necrophorum, other bacteria such as Staphylococcus aureus, E. Coli, and various streptococcal species have been associated with Lemierre's-like syndrome (1,2). Delay in recognition of the syndrome may result in systemic metastasis of infection, including septic thrombophlebitis, lung, and joint infections. CONCLUSIONS: This case highlights the importance of clinical awareness of rare diseases like Lemierre's syndrome. Our patient initially presented with a sore throat but was found to have systemic metastasis of infection, including internal jugular septic thrombophlebitis and lung cavitation. Early recognition and appropriate evaluation are crucial in preventing potentially fatal outcomes. REFERENCE #1: M. A. Baig, J. Rasheed, D. Subkowitz, and J. Vieira, "A review of Lemierre syndrome," Internet Journal of Infectious Diseases, vol. 5, no. 2, 2006. REFERENCE #2: P. D. Karkos, S. Asrani, C. D. Karkos et al., "Lemierre's syndrome: a systematic review," Laryngoscope, vol. 119, no. 8, pp. 1552–1559, 2009. DISCLOSURES: No relevant relationships by Khoi Paul Dang-Ho No relevant relationships by Ryan Kowalsky No relevant relationships by Dhairya Nanavaty No relevant relationships by Dhruv Patel No relevant relationships by Vagdevi Seetamraju No relevant relationships by RISHAV Sinha No relevant relationships by Seungmo Suh