ABSTRACT
The SARS-CoV-2 outbreak has disrupted the delivery of routine healthcare services on a global scale. With many regions suspending the provision of non-essential healthcare services, there is a risk that patients with common treatable illnesses do not receive prompt treatment, leading to more serious and complex presentations at a later date. Lemierre's syndrome is a potentially life-threatening and under-recognised sequela of an oropharyngeal or dental infection. It is characterised by septic embolisation of the gram-negative bacillus Fusobacterium necrophorum to a variety of different organs, most commonly to the lungs. Thrombophlebitis of the internal jugular vein is frequently identified. We describe an atypical case of Lemierre's syndrome involving the brain, liver and lungs following a dental infection in a young male who delayed seeking dental or medical attention due to a lack of routine services and concerns about the SARS-CoV-2 outbreak.
Subject(s)
Brain Abscess , Coronavirus Infections , Critical Care/methods , Delayed Diagnosis , Fusobacterium necrophorum , Liver Abscess, Pyogenic , Multiple Pulmonary Nodules , Pandemics , Pneumonia, Viral , Quarantine , Tooth Diseases , Anti-Bacterial Agents/administration & dosage , Anticoagulants/administration & dosage , Betacoronavirus , Brain Abscess/diagnostic imaging , Brain Abscess/etiology , COVID-19 , Clinical Deterioration , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Diagnosis, Differential , Fusobacterium necrophorum/isolation & purification , Fusobacterium necrophorum/pathogenicity , Humans , Lemierre Syndrome/diagnosis , Lemierre Syndrome/etiology , Lemierre Syndrome/physiopathology , Liver Abscess, Pyogenic/diagnostic imaging , Liver Abscess, Pyogenic/etiology , Liver Abscess, Pyogenic/surgery , Magnetic Resonance Imaging/methods , Male , Multiple Pulmonary Nodules/diagnostic imaging , Multiple Pulmonary Nodules/etiology , Pandemics/prevention & control , Patient Acceptance of Health Care , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Quarantine/methods , Quarantine/psychology , SARS-CoV-2 , Tomography, X-Ray Computed/methods , Tooth Diseases/complications , Tooth Diseases/diagnosis , Tooth Diseases/microbiology , Treatment Outcome , Young AdultABSTRACT
We report a case of a 15-year-old female presenting with a serious multisystemic inflammatory illness during a surge of SARS-CoV-2 (COVID-19) cases in our county. The initial clinical findings of sore throat and neck stiffness, followed by signs of sepsis, raised suspicion of Lemierre syndrome early in her hospital course. However, the presence of severe respiratory distress, multifocal pneumonia with pleural effusion on chest radiograph, acute kidney injury, and the discovery of coronary artery ectasia, pointed to the new entity "multisystem inflammatory syndrome in children (MIS-C)." Immune modulatory treatment was thus considered. However, progressive neck pain and swelling, coupled with the eventual growth of Fusobacterium necrophorum on blood culture, eventually led to the correct diagnosis of Lemierre syndrome.