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Lemierre Syndrome Caused by Group A Streptococci

2007; Lippincott Williams & Wilkins; Volume: 26; Issue: 7 Linguagem: Inglês

10.1097/inf.0b013e31806451fd

1532-0987

Daniel Blumberg, Pierluigi Brazzola, Corinna F. P. Foglia, Elisabetta Fiore, Mario G. Bianchetti,

Infective Endocarditis Diagnosis and Management

To the Editors: Lemierre syndrome, also known as postanginal sepsis, is a severe complication of an acute oropharyngeal infection that results in septic thrombophlebitis of the ipsilateral internal jugular vein with subsequent septicemia, often complicated by metastatic infections. The usual agent in Lemierre syndrome is Fusobacterium necrophorum, a commensal bacillus of the oral cavity.1,2 Several other microorganisms have been implicated alone or in combination with F. necrophorum, including Bacteroides species, group B and C streptococci, Streptococcus oralis, Staphylococcus epidermidis, Enterococcus species, and Proteus mirabilis.1,2 We present the case of a previously healthy 13-year-old boy with Lemierre syndrome caused by group A streptococci. The boy presented to our emergency department in an ill-appearing and uncomfortable state. The physical examination was remarkable for mild dehydration, peripheral cyanosis, and capillary refilling time of 4 to 5 seconds. The left jaw was moderately swollen and tender and mouth opening was restricted precluding adequate oropharyngeal visualization. Vital signs were temperature 36.3°C, pulse 120/min, blood pressure 89/58 mm Hg, respiratory rate 20/min, and oxygen saturation 100%. Laboratory data included normal hemoglobin, total leukocyte count and electrolytes, mild thrombocytopenia (93 × 109/L), and renal failure (urea 9.7 mmol/L, creatinine 146 μmol/L). The C-reactive protein value (254 mg/L) was increased. Doppler ultrasound examination disclosed an intraluminal thrombus occluding the left facial, temporal, and internal jugular veins. Blood cultures drawn before initiating empiric antibiotics subsequently grew Lancefield group A streptococci. The clinical course was uneventful on medication with large-dosage intravenous amoxicillin and anticoagulation, initially with a low-molecular-weight heparin, later changed to warfarin. The boy presented in this report exhibited the distinctive features of Lemierre syndrome, including an acute oropharyngeal infection and a septic jugular thrombosis.1,2 We believe that this is the first report of Lemierre syndrome caused by group A streptococci. The observation may reflect the resurgence in invasive group A streptococcus diseases, such as bacteremia, septic arthritis, pneumonia, peritonitis, puerperal sepsis, necrotizing fasciitis, meningitis, and streptococcal toxic shock syndrome.3 Daniel Blumberg, MD Pierluigi Brazzola, MD Corinna F. P. Foglia, MD Elisabetta Fiore, MD Mario G. Bianchetti, MD Ospedale San Giovanni Bellinzona, Switzerland Ospedale della Beata Vergine Mendrisio, Switzerland [email protected]