LEMIERRE SYNDROME - A RARE CAUSE OF SEPTIC POLYARTHRITIS
Rheumatology, Luton&Dunstable Hospitals NHS Trust, Luton, United Kingdom
Background: Lemierre syndrome is a very rare disease which can cause severe sepsis in previously healthy young adults. The syndrome was described by Andre Lemierre in 1936 who documented 20 cases of throat infection followed by anaerobic septicemia. There are only approximately 170 cases reported in the worldwide literature. In the last 15 years there has been a rise in incidence, possibly related to restriction in antibiotic use for sore throat.
Lemierre syndrome is initiated by an infection of the head and neck region, usually a pharyngitis caused by Fusobacterium necrophorum, a gram negative anaerobe. The bacteria then spread to the internal jugular vein forming a septic thrombus that gives rise to disseminating microemboli causing abscesses. The lungs are most commonly affected followed by the joints (knee, hip,shoulder); although almost any organ can be involved.
Objectives: To report a rare case of Lemierre Syndrome causing septic polyarthritis in a previously healthy young adult
Methods: A previously fit and well 27 year old Zimbabwean male, resident in the UK for the last 10 years, presented to his General Practitioner(GP) with a 1 week history of pharyngitis, fever, vomiting, diarrhoea, generalized arthralgia and myalgia. He denied any recent foreign travel, infectious disease contact or intravenous drug use. He last had unprotected intercourse 3 months previously.
He was initially diagnosed by his GP with possible swine flu (H1N1). Despite completing a course of Tamiflu, his symptoms deteriorated and he presented to hospital. On admission, he was unwell, pyrexial (38.20C), with no palpable lymphadenopathy, but had synovitis of his right shoulder, knee and ankle. Lab tests showed raised inflammatory markers, increased white cell count with neutrophilia,thrombocytosis, normochromic normocytic anaemia & raised bilirubin. Urine dipstick analysis was positive for RBCs & protein. Chest X Ray was normal. Microscopy of the right shoulder and right knee aspirant showed gram negative cocci and he was started on intravenous Benzyl penicillin, Flucloxacillin & Gentamicin.
Results: A CT scan revealed multiple abscesses in his lungs, left ilio- psoas & both gluteal muscles. A transthoracic echocardiogram was normal. A Doppler ultrasound of his right leg revealed multiple calf abscesses. An ultrasound scan of his neck veins was normal. HIV 1&2 antibody and P24 antigen tests were negative. The bacteria were identified as Fusobacterium necrophorum sensitive to Meropenem, Metronidazole & Clindamicin.
He was diagnosed with Lemierre syndrome and was treated with intravenous Meropenem and Metronidazole for 6 weeks. He also had arthroscopic washouts of right shoulder, knee and ankle. He made a good recovery, but had residual right knee swelling and slight restriction to full flexion.
Conclusion: Sepsis with polyarticular involvement in a previously healthy young adult should raise the possibility of Lemierre's syndrome. Prompt diagnosis and aggressive treatment with intravenous antibiotics and drainage of abscesses are necessary to prevent morbidity and fatality.
Disclosure of Interest: None declared
Citation: Annals of the Rheumatic Diseases, volume 69, supplement 3, year 2010, page 706
Session: Infection-related rheumatic diseases
(Abstracts accepted for publication )