Bilateral pterygoid abscesses in a patient with Lemierre's syndrome

BMJ Case Rep. 2023 Jul 17;16(7):e255398. doi: 10.1136/bcr-2023-255398.

Abstract

Patients with Lemierre's syndrome may have complications such as lung lesions, large joint arthritis and central nervous system involvement. However, complications involving a pterygoid abscess have scarcely been reported. Here, we report a case of bilateral Lemierre's syndrome accompanied with an intracranial epidural abscess and bilateral pterygoid abscesses. A woman in her 70s presented to the emergency room with a decreased level of consciousness. Infection was suspected, and Slackia exigua and species of Fusobacterium were identified in blood cultures, which suggested that the origin of infection was odontogenic, particularly as the patient had poor oral hygiene. Head and neck CT with contrast enhancement revealed bilateral internal jugular vein thrombophlebitis, septic pulmonary embolism, frontal epidural abscess and bilateral pterygoid abscesses. After antibiotic treatment and drainage, her condition improved. Pterygoid abscesses should be recognised as a rare complication of Lemierre's syndrome, especially when the infection origin is odontogenic.

Keywords: Dentistry and oral medicine; Infectious diseases.

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Epidural Abscess* / complications
  • Epidural Abscess* / diagnostic imaging
  • Epidural Abscess* / drug therapy
  • Female
  • Fusobacterium necrophorum
  • Humans
  • Jugular Veins / microbiology
  • Lemierre Syndrome* / diagnosis
  • Lemierre Syndrome* / diagnostic imaging
  • Thrombophlebitis* / drug therapy

Substances

  • Anti-Bacterial Agents