Bilateral Lemierre's syndrome: a case report and literature review - Original Article

Ear, Nose & Throat Journal, April, 2002 by Brian A. Moore, Catherine Dekle, Jay Werkhaven

Table 1

Admission laboratory values for the patient in this case report

Test                            Value             Normal range

Leukocyte count                 9.3 [10.sup.9]/L  4.0 to 11.0
% Polymorphonuclear             77.9%             42 to 77
 leukocytes
% Lymphocytes                   14.9%             25 to 40
Hemoglobin                      9.2 g/dl          14.0 to 18.0
Packed cell volume              27%               42 to 50
Prothrombin time                13.7 sec          13.0 to 15.0
International normalized ratio  1.0               N/A
Partial thromboplastin time     33.7 sec          34.0 to 60.0
Fibrinogen                      441 mg/dl         185 to 400
Sodium                          136 mEq/L         135 to 145
Potassium                       4.4 mEq/L         3.5 to 5.0
Chloride                        101 mEq/L         95 to 105
Carbon dioxide                  29 mEq/L          23 to 30
Blood urea nitrogen (BUN)       9 mg/dl           5 to 25
Creatinine                      0.9 mg/dl         0.7 to 1.5
Glucose                         112 mg/dl         70 to 110
Albumin                         1.9 g/dl          3.5 to 5.0
Total bilirubin                 0.8 mg/dl         0.2 to 1.2
Alkaline phosphatase            169 U/L           40 to 110
Serum glutamic oxaloacetic      69 U/L            4 to 40
 transaminase (SGOT)
Serum glutamate pyruvate        73 U/L            4 to 40
 transaminase (SGPT)
Table 2.

Characteristics of 41 cases of Lemierre's syndrome reported since 1988

                           Age/    Primary         Area of
Author                    sex (*)  symptom         extension

Goldhagen et al,           11/M    Gingivitis      Lungs,
 1988 (25)                                         elbow

                           15/F    Pharyngitis     Lungs


                           16/F    Pharyngitis     Lungs

Shapiro et al,             31/F    Pharyngitis     Lungs
 1989 (18)
                           23/F    Pharyngitis     Lungs
Moreno et al,              18/M    Pharyngitis     Lungs
 1989 (26)
Shadowen and               15/M    Pharyngitis     Lungs
 Trevor, 1989 (27)                 (hearing loss)  (hearing loss)
Golledge et al,            20/M    Pharyngitis     Lungs
 1990 (28)
                           17/M    Pharyngitis     Lungs

Chippindale et al,         17/M    Pharyngitis     Lungs
 1990 (29)

Chalstrey et al,           19/M    Pharyngitis     Lungs
 1992 (30)
Weesner and                21/M    Pharyngitis     Lungs
 Cisek, 1993 (8)
Cosgrove et al,            19/M    Pharyngitis     Lungs
 1993 (31)
Carlson et al,             16/M    Pharyngitis     Lungs
 1994 (32)
                           16/M    Pharyngitis     Lungs,
                                                   sternum,
                                                   joints

Ahkee et al,               14/M    Pharyngitis     Lungs
 1994 (33)
Koay et al, 1995 (9)       17/F    Pharyngitis     Lungs, liver


                           23/F    Pharyngitis     Lungs,
                                                   hip (abscess)
Lustig et al, 1995 (10)    27/M    Pharyngitis     Lungs


Karanas et al,             22/M    Pharyngitis     Lungs,
 1995 (34)                                         thigh

Goyal et al, 1995 (48)      8/M    Pharyngitis     Hip (abscess)
Barker et al, 1996 (35)    16/M    Pharyngitis     Lungs

Stahlman et al,            13/M    Pharyngitis     Lungs, joints
 1996 (38)
De Sena et al,             14/F    Pharyngitis     Lungs
 1996 (37)

                           15/F    Pharyngitis     Lungs, blood
                                                   (disseminated
                                                   intravascular
                                                   coagulation)
Moller and Dreijer,        43/M    Pharyngitis     Lungs
 1997 (38)
                           25/M    Pharyngitis     Lungs





                           15/M    Pharyngitis     Lungs

                           33/F    Pharyngitis     Lungs
                                                   (respiratory
                                                   distress
                                                   syndrome)
Gudinchet et al,           15/F    Pharyngitis     Lungs
 1997 (39)

                           17/F    Pharyngitis     Lungs


Venkataraman               20/M    Pharyngitis     Lungs
 and Policar, 1997 (40)

Stallworth and             17/F    Pharyngitis     Lungs, liver
 Carroll, 1997 (41)

Lee et al, 1997  (47)      22/M    Pharyngitis     Gluteal area
                                                   (abscesses)



Williams et al,            15/M    Pharyngitis     Lungs, liver
 1998 (14)

Vandenberg and             17/M    Pharyngitis     Lungs
 Hartig, 1998 (42)

Ellis et al, 1998 (43)     19/M    Pharyngitis     Lungs


Schwartz and               49/M    Gingivitis      Lungs
 Nguyen, 1999 (44)





Alifano at al, 2000 (45)   31/F    Pharyngitis     Lungs


Agarwal et al,             37/F    Pharyngitis     Cranial
 2000 (48)                                         nerves,
                                                   intracranial
                                                   vault

Moore et al, 2OO2 ( )      27/M    Pharyngitis     Lungs



                          Isolated
Author                    pathogen            Treatment

Goldhagen et al,          Fusobacterium       Nafcillin, chloram-
 1988 (25)                necrophorum         phenicol, penicillin;
                                              anticoagulation
                          F necrophorum       Cefoxitin,
                                              gentamicin,
                                              clindamycin
                          F necrophorum       Clindamycin, penicillin;
                                              anticoagulation
Shapiro et al,            Streptococcus       Clindamycin,
 1989 (18)                sanguis             vancomycin, gentamicin
                          F necrophorum       Clindamycin, penicillin
Moreno et al,             F necrophorum       Chloramphenicol,
 1989 (26)                                    cefoxitin; thoracotomy
Shadowen and              F necrophorum       Metronidazole
 Trevor, 1989 (27)
Golledge et al,           F necrophorum       Metronidazole,
 1990 (28)                                    cloxacillin, gentamicin
                          F necrophorum       lmipenem/cilastatin,
                                              tobramycin
Chippindale et al,        F necrophorum       Erythromycin,
 1990 (29)                                    metronidazole;
                                              decortication
Chalstrey et al,          F necrophorum       Penicillin,
 1992 (30)                                    metronidazole
Weesner and               F necrophorum       Penicillin; warfarin
 Cisek, 1993 (8)
Cosgrove et al,           F necrophorum       Antibiotics
 1993 (31)
Carlson et al,            F necrophorum       Cefoxitin, clindamycin
 1994 (32)
                          F necrophorum       Clindamycin,
                                              ceftizoxime, penicillin,
                                              metronidazole;
                                              anticoagulation x 6 mo
Ahkee et al,              F necrophorum       Ticarcillin/clavulanate;
 1994 (33)                                    heparin
Koay et al, 1995 (9)      F necrophorum       Metronidazole,
                                              cefuroxime,
                                              gentamicin
                          F necrophorum       Cefuroxime,
                                              metronidazole
Lustig et al, 1995 (10)   Peptostreptococcus  Vancomycin,
                          spp., group C       ciprofloxacin,
                          Streptococcus spp.  metronidazole
Karanas et al,            F necrophorum       Gentamicin,
 1995 (34)                                    vancomycin,
                                              metronidazole
Goyal et al, 1995 (48)    F necrophorum       Antibiotics
Barker et al, 1996 (35)   F necrophorum       Ampicillin/sulbactam,
                                              gentamicin
Stahlman et al,           F necrophorum       Penicillin; incision
 1996 (38)                                    and drainage
De Sena et al,            Fusobacterium       Ticarcillin/clavulanate,
 1996 (37)                nucleatum           vancomycin;
                                              anticoagulation x 3 mo
                          F necrophorum       Ceftazidime,
                                              ticarcillin/clavulanate,
                                              metronidazole;
                                              anticoagulation x 3 mo
Moller and Dreijer,       Hemolytic Strepto-  Penicillin, gentamicin,
 1997 (38)                coccus spp.         metronidazole
                          F necrophorum,      Cefuroxime,
                          microaerophilic     netilmicin,
                          Streptococcus,      metronidazole
                          Lactobacillus, and
                          Peptostreptococcus
                          spp.
                          F necrophorum       Penicillin, gentamicin,
                                              metronidazole
                          F necrophorum,      Penicillin,
                          Streptococcus,      metronidazole,
                          Bacteroides, and    ciprofloxacin,
                          Candida spp.        fluconazole
Gudinchet et al,          F necrophorum       Ceftriaxone,
 1997 (39)                                    amoxicillin/clavulanate

                          F necrophorum       Ceftriaxone,
                                              amoxicillin/clavulanate

Venkataraman              F necrophorum       Penicillin,
 and Policar, 1997 (40)                       metronidazole

Stallworth and            F necrophorum       Nafcillin, ceftriaxone,
 Carroll, 1997 (41)                           metronidazole

Lee et al, 1997  (47)     F necrophorum       Metronidazole,
                                              penicillin;
                                              heparin,
                                              warfarin x 6 mo

Williams et al,           F necrophorum       Clindamycin; quinsy
 1998 (14)                                    tonsillectomy

Vandenberg and            F necrophorum       Metronidazole
 Hartig, 1998 (42)

Ellis et al, 1998 (43)    F necrophorum       Penicillin, cefotaxime,
                                              metronidazole

Schwartz and              Klebsiella          Ampicillin,
 Nguyen, 1999 (44)        pneumoniae          ciprofloxacin,
                                              metronidazole;
                                              anticoagulation;
                                              external jugular vein
                                              excision

Alifano at al, 2000 (45)  F necrophorum       Penicillin,
                                              metronidazole

Agarwal et al,            F necrophorum       Penicillin,
 2000 (48)                                    metronidazole;
                                              anticoagulation


Moore et al, 2OO2 ( )     F necrophorum       Clindamycin,
                                              ceftriaxone;
                                              anticoagulation x 6 mo


Author                    Outcome

Goldhagen et al,           Cured
 1988 (25)

                           Cured


                           Cured

Shapiro et al,             Cured
 1989 (18)
                           Cured
Moreno et al,              Cured
 1989 (26)
Shadowen and               Cured
 Trevor, 1989 (27)
Golledge et al,            Cured
 1990 (28)
                           Died

Chippindale et al,         Cured
 1990 (29)

Chalstrey et al,           Cured
 1992 (30)
Weesner and                Cured
 Cisek, 1993 (8)
Cosgrove et al,            Cured
 1993 (31)
Carlson et al,             Cured
 1994 (32)
                           Cured



Ahkee et al,               Cured
 1994 (33)
Koay et al, 1995 (9)       Cured


                           Cured

Lustig et al, 1995 (10)    Cured


Karanas et al,             Cured
 1995 (34)

Goyal et al, 1995 (48)     Died
Barker et al, 1996 (35)    Cured

Stahlman et al,            Cured
 1996 (38)
De Sena et al,             Cured
 1996 (37)

                           Cured



Moller and Dreijer,        Cured
 1997 (38)
                           Cured





                           Cured

                           Cured



Gudinchet et al,           Cured
 1997 (39)

                           Cured


Venkataraman               Cured
 and Policar, 1997 (40)

Stallworth and             Cured
 Carroll, 1997 (41)

Lee et al, 1997  (47)      Cured




Williams et al,            Cured
 1998 (14)

Vandenberg and             Cured
 Hartig, 1998 (42)

Ellis et al, 1998 (43)     Cured


Schwartz and               Cured
 Nguyen, 1999 (44)





Alifano at al, 2000 (45)   Cured


Agarwal et al,             Cured
 2000 (48)



Moore et al, 2002 ( )      Cured



(*)Age in years.

( )Present study.