Deep neck space infection and Lemierre’s syndrome caused by Streptococcus anginosus: A case report
Introduction: Deep neck space infections most commonly arise from a septic focus of the mandibular teeth, tonsils, parotid gland, middle ear or sinuses, usually with a rapid onset and frequently with progression to life-threatening complications. Lemierre’s syndrome is classically defined by an orop...
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doaj-fbadd61903344465a9fad916ba0327742021-07-02T12:42:10ZengElsevierIDCases2214-25092020-01-0119Deep neck space infection and Lemierre’s syndrome caused by Streptococcus anginosus: A case reportFábio Videira Santos0Sara Xavier Pires1Cristina Pereira2Lúcia Gonçalves3Sara Martins4Irene Aragão5Serviço de Doenças Infecciosas do Centro Hospitalar Universitário do Porto, Portugal; Unidade de Cuidados Intensivos Polivalentes, Centro Hospitalar Universitário do Porto, Portugal; Corresponding author at: Serviço de Doenças Infecciosas do Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.Serviço de Medicina Interna do Centro Hospitalar Universitário do Porto, Portugal; Unidade de Cuidados Intensivos Polivalentes, Centro Hospitalar Universitário do Porto, PortugalServiço de Anestesiologia do Centro Hospitalar do Centro Hospitalar Universitário do Porto, Portugal; Unidade de Cuidados Intensivos Polivalentes, Centro Hospitalar Universitário do Porto, PortugalServiço de Anestesiologia do Centro Hospitalar de Leiria, Portugal; Unidade de Cuidados Intensivos Polivalentes, Centro Hospitalar Universitário do Porto, PortugalServiço de Medicina Interna do Centro Hospitalar Universitário do Porto, Portugal; Unidade de Cuidados Intensivos Polivalentes, Centro Hospitalar Universitário do Porto, PortugalUnidade de Cuidados Intensivos Polivalentes, Centro Hospitalar Universitário do Porto, PortugalIntroduction: Deep neck space infections most commonly arise from a septic focus of the mandibular teeth, tonsils, parotid gland, middle ear or sinuses, usually with a rapid onset and frequently with progression to life-threatening complications. Lemierre’s syndrome is classically defined by an oropharyngeal infection with internal jugular vein thrombosis followed by metastatic infections in other organs. Case presentation: A 32-year-old female patient, with no significant past medical history, was diagnosed with a dental abscess on her left inferior 3rd molar. Six days later, the condition complicated with severe upper respiratory distress, odynophagia and trismus, and extension of the inflammatory signs to the anterior cervical region, involving the upper airway. Computed tomography scan confirmed extension to submandibular, parapharyngeal and retrosternal spaces), which required nasotracheal intubation due to compromised airway. Urgent and subsequent surgical drainages were performed, alongside with concomitant antibiotic therapy. Additionally, left internal jugular vein thrombosis was described - with later extension to the brachiocephalic vein, without other complications, consistent with Lemierre's syndrome, although without full features. Streptococcus anginosus was identified in the drained pus specimens. The patient made a satisfactory clinical progress and was discharged after 25 days, still under therapeutic hypocoagulation. Conclusion: As deep neck space infections can be life-threatening, clinicians must be aware and not underestimate their potential severity. Lemierre's syndrome is a complication difficult to recognize, which requires additional awareness of the many possible presentations, for appropriate diagnostic studies and therapeutic plan. Keywords: Lemierre’s syndrome, Streptococcus anginosus, Deep neck infectionhttp://www.sciencedirect.com/science/article/pii/S2214250919303087 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Fábio Videira Santos Sara Xavier Pires Cristina Pereira Lúcia Gonçalves Sara Martins Irene Aragão |
spellingShingle |
Fábio Videira Santos Sara Xavier Pires Cristina Pereira Lúcia Gonçalves Sara Martins Irene Aragão Deep neck space infection and Lemierre’s syndrome caused by Streptococcus anginosus: A case report IDCases |
author_facet |
Fábio Videira Santos Sara Xavier Pires Cristina Pereira Lúcia Gonçalves Sara Martins Irene Aragão |
author_sort |
Fábio Videira Santos |
title |
Deep neck space infection and Lemierre’s syndrome caused by Streptococcus anginosus: A case report |
title_short |
Deep neck space infection and Lemierre’s syndrome caused by Streptococcus anginosus: A case report |
title_full |
Deep neck space infection and Lemierre’s syndrome caused by Streptococcus anginosus: A case report |
title_fullStr |
Deep neck space infection and Lemierre’s syndrome caused by Streptococcus anginosus: A case report |
title_full_unstemmed |
Deep neck space infection and Lemierre’s syndrome caused by Streptococcus anginosus: A case report |
title_sort |
deep neck space infection and lemierre’s syndrome caused by streptococcus anginosus: a case report |
publisher |
Elsevier |
series |
IDCases |
issn |
2214-2509 |
publishDate |
2020-01-01 |
description |
Introduction: Deep neck space infections most commonly arise from a septic focus of the mandibular teeth, tonsils, parotid gland, middle ear or sinuses, usually with a rapid onset and frequently with progression to life-threatening complications. Lemierre’s syndrome is classically defined by an oropharyngeal infection with internal jugular vein thrombosis followed by metastatic infections in other organs. Case presentation: A 32-year-old female patient, with no significant past medical history, was diagnosed with a dental abscess on her left inferior 3rd molar. Six days later, the condition complicated with severe upper respiratory distress, odynophagia and trismus, and extension of the inflammatory signs to the anterior cervical region, involving the upper airway. Computed tomography scan confirmed extension to submandibular, parapharyngeal and retrosternal spaces), which required nasotracheal intubation due to compromised airway. Urgent and subsequent surgical drainages were performed, alongside with concomitant antibiotic therapy. Additionally, left internal jugular vein thrombosis was described - with later extension to the brachiocephalic vein, without other complications, consistent with Lemierre's syndrome, although without full features. Streptococcus anginosus was identified in the drained pus specimens. The patient made a satisfactory clinical progress and was discharged after 25 days, still under therapeutic hypocoagulation. Conclusion: As deep neck space infections can be life-threatening, clinicians must be aware and not underestimate their potential severity. Lemierre's syndrome is a complication difficult to recognize, which requires additional awareness of the many possible presentations, for appropriate diagnostic studies and therapeutic plan. Keywords: Lemierre’s syndrome, Streptococcus anginosus, Deep neck infection |
url |
http://www.sciencedirect.com/science/article/pii/S2214250919303087 |
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