Lemierre Syndrome three weeks after COVID-19 infection
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Lemierre’s syndrome is a rare disease that classically presents with septicemia, thrombophlebitis, and distal embolization that develops 1-3 weeks after an oropharyngeal infection. Fusobacterium necrophorum is the causative pathogen in the majority of cases. It has been hypothesized that preceding oropharyngeal infection leads to mucosal damage, which allows the penetration of Fusobacterium into the pharyngeal space and internal jugular vein. There have been reported links between Lemierre’s syndrome and viral infections such as Epstein Barr virus and influenza [1- 3]. Early diagnosis of Lemierre’s syndrome can be challenging due to its overlapping symptoms with other infections. Moreover, Fusobacterium grows slowly in cultures resulting in further delay in diagnosis. The timely administration of appropriate antibiotic therapy is crucial as mortality without antibiotic administration can reach up to 90% [4]. We present the case of a 29- year-old male who was diagnosed with Lemierre’s syndrome 3 weeks after a COVID-19 infection. He presented with sepsis syndrome, solitary lung abscess, and cutaneous infarcts. The diagnosis was established after blood cultures grew Fusobacterium necrophorum and imaging revealed left internal jugular thrombus. This case demonstrates some of the difficulties in early diagnosis of Lemierre’s syndrome in the setting of the COVID-19 pandemic due to similarities in presentation.
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License.