Lemierre's syndrome variant of the gut

BMJ Case Rep. 2017 Oct 20:2017:bcr2017221567. doi: 10.1136/bcr-2017-221567.

Abstract

Infectious suppurative thrombophlebitis of the portal venous system, referred to as pylephlebitis, is a rare complication of intra-abdominal inflammatory processes. Advances in diagnostics and antibiotics have improved survival, but mortality remains remarkably high even in the most recent literature. The majority of patients have concomitant bacteraemia on presentation most commonly with typical gastrointestinal (GI) organisms. On rare occasion, patients have culture positive Fusobacterium, which has recently been associated with occult GI and genitourinary malignancies. Here, we describe a patient presenting with pylephlebitis and Fusobacterium bacteraemia who responded well to medical therapy, review pertinent literature and discuss the benefits of screening endoscopy in this patient population.

Keywords: haematology (incl blood transfusion); infection (gastroenterology); infectious diseases.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Abdominal Pain / microbiology
  • Anti-Bacterial Agents / therapeutic use*
  • Anticoagulants / therapeutic use
  • Endoscopy, Gastrointestinal
  • Ertapenem
  • Fever / microbiology
  • Fusobacterium Infections / drug therapy
  • Fusobacterium Infections / microbiology*
  • Fusobacterium Infections / physiopathology
  • Fusobacterium necrophorum / isolation & purification*
  • Heparin / therapeutic use
  • Humans
  • Lemierre Syndrome / drug therapy
  • Lemierre Syndrome / microbiology*
  • Lemierre Syndrome / physiopathology
  • Male
  • Penicillanic Acid / analogs & derivatives
  • Penicillanic Acid / therapeutic use
  • Phlebitis / microbiology*
  • Piperacillin / therapeutic use
  • Piperacillin, Tazobactam Drug Combination
  • Portal Vein
  • Treatment Outcome
  • beta-Lactams / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Anticoagulants
  • beta-Lactams
  • Piperacillin, Tazobactam Drug Combination
  • Penicillanic Acid
  • Heparin
  • Ertapenem
  • Piperacillin