"Central nervous system (CNS) complications are rare because cerebral veins are located upstream from the IJV. Nonetheless, subdural empyema [26,27], cerebral infarcts [28–30], meningitis [29,31,32], encephalopathy , and cavernous sinus thrombosis have been reported, with the probable mechanism being retrograde extension of IJV thrombosis [30,34–42]. "
[Show abstract][Hide abstract] ABSTRACT: Patient: Male, 25Final Diagnosis: Lemierre’s diseaseSymptoms: Back pain • fever • headache • tachycardia • tachypnoeMedication: —Clinical Procedure: —Specialty: Infectious DiseasesObjective:Rare diseaseBackground:Lemierre’s disease, also known as the forgotten disease, postanginal sepsis, or necrobacillosis, was first reported in 1890 by Courmont and Cade, but it was Dr. Andre Lemierre, a professor of microbiology, who described this disease in 1936. The typical causative agent is Fusobacterium necrophorum, although other organisms may be involved. The pathogenesis of Lemierre’s disease is not well understood. It is characterized by a primary oropharyngeal infection associated with septicemia, internal jugular vein thrombosis, and metastatic septic emboli.Case Report:We report a case of Lemierre’s disease with bilateral internal jugular vein (IJV) thrombosis and metastatic septic emboli to the lungs and brain, associated with epidural abscess and mycotic aneurysm of the vertebral artery, which is quite rare in Lemierre’s disease. This is the first report of a case of Lemierre’s disease associated with mycotic aneurysm of the vertebral artery.Conclusions:Lemierre’s disease is a rare and perplexing medical entity. Clinical suspicion should be high in previously healthy young adults presenting with fever and neck pain following oropharyngeal infection. Dr. Lemierre stated that ‘symptoms and signs of Lemierre’s disease are so characteristic that it permits diagnosis before bacteriological examination’. The prognosis of patients with Lemierre’s disease is generally good, provided prompt recognition and appropriate treatment.
American Journal of Case Reports 05/2014; 15:230-4. DOI:10.12659/AJCR.890449
"Several atypical variants of LS were previously described. Their misunderstanding can delay the diagnosis and management of this rare disease . The present article documents a neurologic variant of LS, occurring in a previously healthy 10-year-old girl, and revealed by septic shock with otitis media as the primary source of infection and meningitis as metastatic location. "
[Show abstract][Hide abstract] ABSTRACT: THE AIM of this study is to determine factors predicting development of chronic thrombocytopenic idiopathic purpura.
It was a retrospective study, regarding the cases of PTI diagnosed in "service de medicine infantile C Hôpital d'Enfants de Tunis" during 11 years. A comparison was done between two groups: the first including acute PTI and the second including chronic and recurrent PTI. Factors predicting development of chronic disease were searched by the Fisher test which was significant when p < 0.05.
33 cases of PTI were diagnosed. The ratio sex was 1.06. The mean age was five years and a half. The disease onset was insidious in three cases; all of them have had a chronic course. An haemorrhagic personnel background was present in three cases. Counselling cause was always petechies and ecchymoses. The mean platelets rate was 14555.5/mm3. Therapeutics abstinence was carried out in five cases. 20 infants received an initial corticotherapy. The immunoglobulins were prescribed in nine cases, witch six associated to Corticotherapy. Three modes of outcome were discerned: acute PTI (n = 23), recurrent PTI (n = 4) and chronic PTI (n = 6). Factors predicting development of chronic disease were: haemorrhagic personnel background, an insidious disease onset and the failure of an initial therapeutic abstinence.
Acute PTI is the most common. The disease had a chronic or recurrent outcome in 1/3 of cases. The search after factors predicting chronic disease allows an early prognosis. Thus, a best management of the disease can be achieved.
[Show abstract][Hide abstract] ABSTRACT: We report an unusual variant of Lemierre's Syndrome (LS) in a 10-year-old-girl admitted to the intensive care unit for septic shock with meningitis. The primary infection was otitis media. A gram negative bacillus was identified in the direct exam of the purulent ear discharge and the cerebrospinal fluid but cultures were negative. Computerized tomography of the neck revealed a thrombus in the internal jugular vein. Septic shock improved rapidly under supportive treatment. The patient recovered without sequellae after a prolonged duration of parenteral antibiotherapy and hospital stay. Neurologic variants of LS with meningitis, previously reported in the literature, are reviewed.
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