Angina, back pain and septic shock

Excerpt

A 48-year-old man presented to the emergency department with back pain, fever and confusion, 1 week after a sore throat ascribed to pharyngitis. The patient was admitted to the ICU for septic shock and a computed tomography (CT) was performed. CT depicted an air infiltration of the D8 vertebral body, diffuse epidural pneumatosis, pneumomediastinum and pulmonary nodules (Fig. 1a, b). Because of the initial pharyngitis, we suspected the possibility of Lemierre’s syndrome, a complication of oropharyngeal infection defined by septic thrombophlebitis of the internal jugular vein (Fig. 1c) and distal emboli that most commonly involved the lungs [1]. Most cases are caused by Fusobacterium necrophorum, which was identified in the patient’s blood cultures and cerebrospinal fluid. The symptomatology was finally attributed to Lemierre’s syndrome with an unusual case of vertebral dissemination. The patient received intravenous amoxicillin for 4 weeks and metronidazole for 8 weeks. Considering that some strains have been reported to produce β-lactamases, metronidazole is commonly prescribed for its bactericidal activity and excellent penetration into most tissues. The combination of β-lactam and metronidazole achieves coverage of co-infecting oral streptococci. The patient fully recovered and was discharged from the hospital on day 35.

…