An Unusual Presentation of a Patient with Covid-19 Infection—Lemierre’s Syndrome

Year 2022, Volume: 32 Issue: 3, 68 - 70, 28.09.2022

Orhan Asya , Semih Karaketir , Mustafa Özdemir Atacan Akmeşe

https://doi.org/10.26650/Tr-ENT.2022.1075548

Abstract

Lemierre’s syndrome refers to septic thrombophlebitis of the internal jugular vein that is rarely seen after an oropharyngeal infection. We present the case of a 64-year-old female patient with Covid-19 infection and Lemierre’s syndrome. Contrast-enhanced computed tomography of the neck revealed thrombosis in the left internal jugular vein and non-contrast-enhanced computed tomography of the thorax was consistent with Covid- 19 infection. The patient was immediately hospitalized. Systemic antibiotics, anticoagulation therapy, and favipiravir treatment for Covid-19 infection were started. Unfortunately, the patient died about two weeks after hospitalization. To the best of our knowledge, this is the first case of Lemierre’s syndrome and Covid-19 overlap. Clinical suspicion of Lemierre’s syndrome is important for rapid diagnosis. During this Covid-19 pandemic, we should keep in mind that any patient may have Covid-19 infection. In addition to the patient’s primary disease, with clinical or laboratory suspicion of Covid-19 infection, diagnostic tests for it should also be conducted.

Keywords

Lemierre’s syndrome, internal jugular vein thrombosis, Covid-19 infection, deep neck infection

References

• 1. Johannesen KM, Bodtger U. Lemierre’s syndrome: current perspectives on diagnosis and management. Infection and drug resistance. 2016;9:221-7. google scholar
• 2. Prokop M, Van Everdingen W, van Rees Vellinga T, Quarles van Ufford H, Stöger L, Beenen L, et al. CO-RADS: a categorical CT assessment scheme for patients suspected of having COVID-19— definition and evaluation. Radiology 2020;296(2):E97-104. google scholar
• 3. Syed MI, Baring D, Addidle M, Murray C, Adams C. Lemierre syndrome: two cases and a review. Laryngoscope 2007;117(9):1605-10. google scholar
• 4. Armstrong AW, Spooner K, Sanders JW. Lemierre’s syndrome. Curr Infect Dis Rep 2000;2(2):168-73. google scholar
• 5. Sinave CP, Hardy GJ, Fardy PW. The Lemierre syndrome: suppurative thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection. Medicine 1989;68(2):85-94. google scholar
• 6. Riordan T. Human infection with Fusobacterium necrophorum (Necrobacillosis), with a focus on Lemierre’s syndrome. Clin Microbiol Rev 2007;20(4):622-59. google scholar
• 7. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. google scholar
• 8. Liao D, Zhou F, Luo L, Xu M, Wang H, Xia J, et al. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: a retrospective cohort study. Lancet Haematol 2020;7(9):e671-8. google scholar
• 9. Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost 2020;18(7):1559-61. google scholar
• 10. Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol 2020;7(6):e438-40. google scholar
• 11. Moreno S, Altozano JG, Pinilla B, Lopez J, de Quiros B, Ortega A, et al. Lemierre’s disease: postanginal bacteremia and pulmonary involvement caused by Fusobacterium necrophorum. Rev Infect Dis 1989;11(2):319-24. google scholar
• 12. Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ. The evolution of Lemierre syndrome: report of 2 cases and review of the literature. Medicine 2002;81(6):458-65. google scholar
• 13. Karkos PD, Asrani S, Karkos CD, Leong SC, Theochari EG, Alexopoulou TD, et al. Lemierre’s syndrome: a systematic review. Laryngoscope 2009;119(8):1552-9. google scholar
• 14. Bondy P, Grant T. Lemierre’s syndrome: what are the roles for anticoagulation and long-term antibiotic therapy? Ann Otol Rhinol Laryngol 2008;117(9):679-83. google scholar