Tuberc Respir Dis.  2015 Jul;78(3):289-292. 10.4046/trd.2015.78.3.289.

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

• Choi BM
• Son SW
• Park CK
• Lee SH
• Yoon HK

• KMID: 2320659
• DOI: http://doi.org/10.4046/trd.2015.78.3.289

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.

Keyword

Lemierre Syndrome; Lung Adenocarcinoma; Methicillin Resistance; Staphylococcus epidermidis

MeSH Terms

Adenocarcinoma*
Anti-Bacterial Agents
Ceftriaxone
Female
Humans
Incidence
Jugular Veins
Lemierre Syndrome*
Lung*
Methicillin Resistance*
Middle Aged
Pulmonary Embolism
Retropharyngeal Abscess
Staphylococcus epidermidis*
Stents
Thrombophlebitis
Vena Cava, Superior
Anti-Bacterial Agents
Ceftriaxone

Figure

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  Figure 1 Sagittal images from an initial contrast-enhanced neck computed tomography scan show a retropharyngeal abscess (arrowheads).

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  Figure 2 Axial computed tomography images of the thorax show enlarged bilateral internal jugular veins and thrombosis (arrows).

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  Figure 3 (A) Initial venography shows impaired blood flow in the right internal jugular vein (IJV) and superior vena cava (SVC). (B) Follow-up venography reveals improved blood flow after catheter-directed thrombolysis and SVC stenting (arrowheads). (C) Computed tomography at 6 months after treatment shows resolution of the thrombosis and intact blood flow in both IJV and SVC (arrows).

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