Peritonsillar abscess with life-threatening consequences

Introduction Lemierre syndrom is a late complication of a bacterial pharyngitis, associated with high mortality in young and healthy patients. It was relatively common in the preantibiotic era but is nowadays a rare but potentially life-threatening complication. It is caused by anaerobic bacteria, most typically Fusobacterium necrophorum. It is characterized by septic thrombophlebitis of the internal jugular vein and septicemia.

Material and methods In this case report we present the history of a 27-year-old patient visiting our emergency room with throat pain. In our investigation, we found a peritonsillar abscess on the left side, a thrombosis of the left internal jugular vein and several septic embolic events in lung, liver and kidneys. He had an acute kidney failure and was close to a septic shock.

Results The therapy involved the surgical abscess-tonsillectomy, broad-spectrum antibiotic therapy, anticoagulation and intensive care monitoring. Under this therapy the patient stabilized. The antibiotic treatment was continued for 3 weeks and the anticoagulation for at least 3 months.

Conclusion Although being a rare complication of pharyngitis, Lemierre syndrome should be considered as a differential diagnosis when patients present themselves under septic conditions. A rapid recognition of the Lemierre syndrome and a fast start with the antibiotic and anticoagulative therapy is essential for a positive outcome.

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Artikel online veröffentlicht:
13. Mai 2024