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A case of Lemierre's syndrome with double vision as the first symptom
Institution:1. Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan;2. Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan;3. Department of Respiratory Medicine, Nagasaki Aino Memorial Hospital, Nagasaki, Japan;4. Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan;5. Department of Radiology, Nagasaki University Hospital, Nagasaki, Japan;6. Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan;1. Department of Laboratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China;2. Department of Blood Transfusion, Affiliated Hospital of Zunyi Medical University, Zunyi, China;3. School of Laboratory Medicine, Zunyi Medical University, Zunyi, China;1. Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan;2. Department of Urology, JA Mie Komono Kosei Hospital, Fukumura 75, Komono-cho, Mie-gun, Mie, 510-1234, Japan;3. Infection Control Team, JA Mie Komono Kosei Hospital, Fukumura 75, Komono-cho, Mie-gun, Mie, 510-1234, Japan;1. Research Center for Infection Control, ōmura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan;2. External Innovation, Drug Research Division, Sumitomo Dainippon Pharma Co., Ltd, Japan;1. Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, 77000, Melun, France;2. Department of Infectious Diseases, Nord Franche-Comté Hospital, 90400, Trévenans, France;3. Department of Clinical Immunopathology, Saint-Louis Hospital, University of Paris, 75010, Paris, France;1. Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan;2. Department of Microbiology, Faculty of Pharmacy, Meijo University, Nagoya, Japan;3. Department of Digestive Tract Internal Medicine, Tokyo General Hospital, Tokyo, Japan;4. Department of Clinical Laboratory, Tokyo General Hospital, Tokyo, Japan
Abstract:Lemierre's syndrome is a serious disease that typically causes oropharyngeal infection with internal jugular vein thrombosis, followed by distant infection focus, such as septic pulmonary embolism. The main causative organisms are anaerobic bacteria in the oral cavity, namely Fusobacterium necrophorum. We encountered an extremely rare case of Lemierre's syndrome, where double vision was found to be the first symptom. The patient's blood culture results showed the presence of F. nucleatum, which spread from the sphenoid sinus to the skull base because of chronic sinusitis; the patient presented with longus colli abscess, clivus osteomyelitis, venous thrombosis, and hematogenous infection. Antibiotic treatment with sulbactam/ampicillin was continued for 14 weeks, and no recurrence has been observed so far. Lemierre's syndrome can be complicated with atypical symptoms such as double vision if the cranial nerves are involved. It might be important to consider this disease in the differential diagnosis in the presence of cranial nerve symptoms of unknown origin with fever or inflammatory findings.
Keywords:Lemierre's syndrome  Double vision  Fusobacterium  Clivus osteomyelitis
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