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Case Report
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| An atypical presentation of Lemierre's syndrome with eye and facial pain: A case report with Streptococcus intermedius | ||||||
| Jordana Cheta | ||||||
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Critical Care and Nephrology Fellow, Eastern Virginia Medical School, 855 W. Brambleton Avenue, Norfolk, VA 23510 United States.
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| How to cite this article |
| Cheta J. An atypical presentation of Lemierre's syndrome with eye and facial pain: A case report with Streptococcus intermedius. Int J Case Rep Images 2016;7(12):848–852. |
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Abstract
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Introduction:
Lemierre's syndrome is rare but morbid complication that follows an acute oropharyngeal infection. Seeding of an oropharyngeal infection into the lateral pharyngeal space can result in thrombosis of the internal jugular vein with subsequent septic metastasis. The most common presenting symptoms are fever, pharyngitis, odynophagia, oropharyngeal swelling and neck pain. The most common etiologic agent is Fusobacterium necrophorum. We are reporting a rare case in which the causative agent was Streptococcus intermedius and the presenting symptoms were atypical. To the best of our knowledge this is the 4th case of Streptococcus intermedius, resulting from a gingival procedure, with a normal oropharyngeal exam at time of presentation.
Case Report: We describe a 78-year-old Caucasian female presented with eye and facial pain, which resulted to be Lemierre's syndrome. Blood cultures grew Streptococcus intermedius. Patient's hospital course was complicated by parapharyngeal and masticator abscesses. Prompt treatment was initiated and the patient made a full recovery. Conclusion: In the presented case, we had a patient in whom the presenting symptom was mistaken for facial cellulitis resulting in a delay of treatment and progression of symptoms. The presentation was not the typical symptoms of Lemierre's syndrome, such as neck pain, pharyngitis, odynophagia, and fever. Likewise, the blood culture did not grow the usual causative bacteria. Due to the implementation of early treatment, which results in improved outcomes and decreased rates of complications, dependent upon early recognition of the disease, we are reporting this previously undescribed manifestation in hopes to increase awareness across multiple specialties of medicine. | |
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Keywords:
Atypical Lemierre's presentation, Facial swelling, Streptococcus intermedius infection, Thrombophlebitis of internal jugular vein
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Author Contributions
Jordana Cheta – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2016 Jordana Cheta. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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