[Lemierre syndrome caused by Arcanobacterium haemolyticum: a case report and review of the literature].

OBJECTIVE

To emphasize the importance of the early diagnosis and treatment of Lemierre syndrome caused by Arcanobacterium haemolyticum.

METHODS

A case of Lemierre syndrome caused by Arcanobacterium haemolyticum and three similar reported cases were reviewed.

RESULTS

A man complained of fever with a sore throat, and examination found an enlarged left tonsil with prominent exudate, normal blood routine test and chest radiograph. Although the patient received the treatment of penicillin G and azithromycin, his condition worsened. Blood test showed white blood cell count 13.59×10(9)/L (neutrophils 0.933), platelet count 7.4×10(9)/L, TBil 54.3 mmol/L, DBil 28.3 mmol/L, AST 127 IU/L, ALT 82 IU/L, serum albumin 19.3 g/L with the development of the conditions. Blood cultures grew Arcanobacterium haemolyticum and the piperacillin-tazobactam was administered until fever was controlled. In addition, anticoagulation was administered when the thrombus was confirmed in the left internal jugular vein. Two follow-up clinic visits over the following 4 months were unremarkable. Besides three similar cases reported, four patients were male, and the ages ranged from 19 to 54 years. The chief complaints were sore throat and fever (4/4), with neck pain (4/4). Physical examinations found pharyngitis (2/4), exudate or abscess in the tonsillar crypt (2/4), maculopapular rashes (2/4). Laboratory results showed leukocytosis and thrombocytopaenia (4/4), acute cholestatic liver dysfunction (3/4), acute renal failure (2/4), acute respiratory failure (1/4). The first chest radiographs were normal at the onset, but chest radiography features included peripheral nodules and cavitation (3/4), focal or wedge-shaped lesions (1/4), pleural effusion (1/4) with the development of the conditions. Blood culture proved that there was only growth of Arcanobacterium haemolyticum (2/4), both Fusobacterium necrophorum and Arcanobacterium haemolyticum were found (2/4). Amoxicillin/clavulanic acid or piperacillin/tazobactam was administered (4/4). Neck CT proved internal jugular vein thrombosis (3/4) and anticoagulation was administered (3/4). All patients recovered and no one died.

CONCLUSIONS

The characters of Lemierre syndrome include primary oropharynx infection, septicaemia, septic or embolic phlebitis of jugular vein, and metastatic abscess. Early recognition and aggressive intravenous broad-spectrum antibiotics are critical to reduce mortality.