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Published on: June 15, 2019
Lemierre's syndrome, necrotizing pneumonia and staphylococcal septic shock treated with extracorporeal life support
Adrian C Mattke1,2,3,4,5, Sudesh Prabhu1,2,3, Julia Clark2,6
1Queensland Paediatric Cardiac Services, Lady Cilento Children's Hospital (LCCH), South Brisbane, QLD, Australia.
Objectives:
Lemierre's syndrome cause by methicillin-sensitive Staphylococcus aureus is rare, but can lead to necrotizing pneumonia and septicaemia. When treating such patient with extracorporeal life support source control can be both challenging and controversial.
Methods:
In this report we present a 12 year old male who presented with Lemierre's syndrome from which he developed septic shock and severe necrotizing pneumonia. He also showed multiple pulmonary embolisms from the internal jugular vein thrombi, resulting in acute respiratory distress syndrome.
Results:
The patient was treated with extracorporeal life support. Subsequent computed tomography revealed multiple abscesses throughout his lungs and around vertebral bodies C1 and C2, for which source control with drainage of the cervical abscesses was achieved while on extracorporeal life support. The necrotizing pneumonia gradually improved, and partial pneumectomy was avoided. He was successfully separated from extracorporeal life support and respiratory support and recovered from his illness. Follow-up imaging showed almost complete resolution of the pulmonary abscesses. Osteomyelitis of C1/C2 and severe muscle wasting required a prolonged hospital stay.
Conclusion:
This case highlights the challenges of supporting patients suffering from disseminated staphylococcal sepsis with extracorporeal life support and the key role of source control and demonstrates the value of using extracorporeal life support in necrotizing pneumonia.
Insights
This case study shows extracorporeal life support (ECLS) can successfully treat severe Lemierre's syndrome and necrotizing pneumonia caused by Staphylococcus aureus. Prompt source control, even during ECLS, is crucial for recovery.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pulmonology
Background:
- Lemierre's syndrome, a rare but severe complication of oropharyngeal infections, often caused by methicillin-sensitive Staphylococcus aureus, can lead to life-threatening conditions like necrotizing pneumonia and septicemia.
- Management of Lemierre's syndrome, particularly when complicated by severe necrotizing pneumonia and septic shock, presents significant challenges, especially concerning source control in patients requiring extracorporeal life support (ECLS).
Observation:
- A 12-year-old male presented with Lemierre's syndrome, progressing to septic shock, severe necrotizing pneumonia, and acute respiratory distress syndrome due to multiple pulmonary embolisms from internal jugular vein thrombi.
- Computed tomography revealed extensive pulmonary abscesses and cervical abscesses involving vertebral bodies C1 and C2.
Findings:
- The patient was successfully managed with ECLS, enabling source control through drainage of cervical abscesses while on support.
- Necrotizing pneumonia gradually improved, avoiding the need for partial pneumectomy, and the patient was weaned from ECLS and respiratory support.
- Follow-up imaging demonstrated near-complete resolution of pulmonary abscesses, though osteomyelitis of C1/C2 and muscle wasting necessitated extended hospitalization.
Implications:
- This case underscores the critical role of source control in managing disseminated staphylococcal sepsis, even in patients supported by ECLS.
- It highlights the value of ECLS as a life-saving intervention for severe necrotizing pneumonia secondary to Lemierre's syndrome.
- Effective multidisciplinary management, including timely surgical intervention and advanced life support, is essential for favorable outcomes in complex infectious disease cases.
