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The forgotten disease: Bilateral Lemierre’s disease with mycotic aneurysm of the vertebral artery

Challenging differential diagnosis, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)

Tanush Gupta, Kaushal Parikh, Sonam Puri, Sahil Agrawal, Nikhil Agrawal, Divakar Sharma, Lawrence DeLorenzo

USA Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, USA

Am J Case Rep 2014; 15:230-234

DOI: 10.12659/AJCR.890449

Available online:

Published: 2014-05-25


#890449

Background: Lemierre’s disease, also known as the forgotten disease, postanginal sepsis, or necrobacillosis, was first reported in 1890 by Courmont and Cade, but it was Dr. Andre Lemierre, a professor of microbiology, who described this disease in 1936. The typical causative agent is Fusobacterium necrophorum, although other organisms may be involved. The pathogenesis of Lemierre’s disease is not well understood. It is characterized by a primary oropharyngeal infection associated with septicemia, internal jugular vein thrombosis, and metastatic septic emboli.
Case Report: We report a case of Lemierre’s disease with bilateral internal jugular vein (IJV) thrombosis and metastatic septic emboli to the lungs and brain, associated with epidural abscess and mycotic aneurysm of the vertebral artery, which is quite rare in Lemierre’s disease. This is the first report of a case of Lemierre’s disease associated with mycotic aneurysm of the vertebral artery.
Conclusions: Lemierre’s disease is a rare and perplexing medical entity. Clinical suspicion should be high in previously healthy young adults presenting with fever and neck pain following oropharyngeal infection. Dr. Lemierre stated that ‘symptoms and signs of Lemierre’s disease are so characteristic that it permits diagnosis before bacteriological examination’. The prognosis of patients with Lemierre’s disease is generally good, provided prompt recognition and appropriate treatment.

Keywords: Aneurysm, Infected - microbiology, Lemierre Syndrome, Thrombosis



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