An Unusual Etiology of Lemierre-Like Syndrome: Preseptal Cellulitis due to Methicillin-Resistant Staphylococcus...

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Internal Medicine

Background:

• Lemierre's syndrome (LS) is a severe condition typically caused by oropharyngeal infection with *Fusobacterium necrophorum*, leading to internal jugular vein thrombophlebitis and septic emboli.
• Lemierre-like syndrome (LLS) shares LS pathophysiology but involves different pathogens or infection sources.
• Young adults are the predominant demographic affected by LS.

Observation:

• A case of LLS is presented in a patient with untreated preseptal cellulitis and methicillin-resistant *Staphylococcus aureus* (MRSA) bacteremia, linked to injection drug use.
• Clinical presentation included tachypnea, rhonchi, severe periorbital edema, and bilateral eyelid edema.
• Imaging revealed bilateral preseptal and orbital cellulitis, internal jugular vein thrombosis, and pulmonary cavitary lesions indicative of septic emboli.

Findings:

• This case represents the first documented instance of LLS originating from preseptal cellulitis without preceding pharyngitis.
• The etiology was identified as MRSA bacteremia.
• Successful management involved anticoagulation and parenteral antibiotics.

Implications:

• Facial and orbital infections, though rare, should be considered potential triggers for LLS.
• Early recognition and broad differential diagnosis are crucial for managing LLS due to its potentially fatal outcomes.
• This case expands the known spectrum of infectious etiologies for Lemierre-like syndrome.