Lemierre syndrome with pulmonary empyema caused by Prevotella intermedia

Area of Science:

• Infectious Diseases
• Microbiology
• Pulmonology

Background:

• Lemierre syndrome is a rare thrombophlebitis of the internal jugular vein, often preceded by oropharyngeal infection.
• Fusobacterium necrophorum is the most common bacterial pathogen implicated in Lemierre syndrome.
• Prevotella intermedia is an uncommon cause of Lemierre syndrome, typically associated with periodontal disease.

Observation:

• A young, healthy male presented with symptoms consistent with Lemierre syndrome.
• The patient developed significant complications, including multiple cavitary lung lesions and loculated pleural effusions requiring chest tube intervention.
• A trapezius abscess was also noted, indicating extensive soft tissue involvement.

Findings:

• Cultures identified Prevotella intermedia as the causative agent, a rare etiology for Lemierre syndrome.
• The patient's clinical course was characterized by a protracted response to appropriate antimicrobial therapy.
• The extensive metastatic disease to the lungs and soft tissues complicated the management and prolonged recovery.

Implications:

• This case underscores Prevotella intermedia as a potential, albeit rare, pathogen in Lemierre syndrome.
• It highlights the importance of considering diverse microbial agents in Lemierre syndrome, even in immunocompetent individuals.
• The protracted clinical course emphasizes the need for prolonged and potentially aggressive management strategies for severe Lemierre syndrome, regardless of the specific pathogen identified.