Title:
Otogenic Lemierre syndrome: clinical diagnosis and urgent mastoidectomy
Authors:
A.-S. Despeghel, K. Samoy, E. D’heygere, J. Casselman, B. Lerut, R. Kuhweide
Institutions:
AZ Sint-Jan Bruges-Ostend, Ruddershove 10, 8000 Bruges, Belgium; University Hospitals Leuven, Herestraat 33, Leuven, Belgium.
Keywords:
Lemierre syndrome; Fusobacterium necrophorum; mastoiditis
Pages:
147 - 153
Abstract:
Problem: Lemierre syndrome is an infectious thrombophlebitis of the internal jugular vein commonly caused by Fuso bacterium necrophorum. In young children, the diagnosis is often delayed due to lack of typical signs of mastoiditis. Cases: Two young girls presented to the emergency department with progressive fever, otalgia, otorrhea, and torticollis. Both were receiving antibiotics. Computerized tomography (CT) of the temporal bone showed opacified mastoid, with extensive thrombus of the internal jugular vein and sigmoid sinus. Case 1 underwent an urgent mastoidectomy with bilateral placement of ventilation tubes, and her antibiotic treatment was switched to ceftriaxone, metronidazole, and vancomycin. Case 2 was immediately started on triple intravenous antibiotic therapy after placement of ventilation tubes. Amastoidectomy was needed later due to deterioration of her clinical condition. Bacterial cultures were negative in both patients. Conclusion: Diagnosis of otogenic Lemierre syndrome should be based on severe ear infections complicated by thrombophlebitis on imaging.
Issue:
Vol. 15, 2019, 2nd trimester


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Otogenic Lemierre syndrome: clinical diagnosis and urgent mastoidectomy