Necrotizing Fasciitis and Thrombophlebitis: Lemierre’s-Like Syndrome
Journal name: The Malaysian Journal of Medical Sciences
Original article title: Necrotizing Fasciitis on the Right Side of the Neck with Internal Jugular Vein Thrombophlebitis and Septic Emboli: A Case of Lemierre’s-Like Syndrome
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Dang NGUYEN, Yazmin YAACOB, Hamzaini HAMID, Sobri MUDA
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: Necrotizing Fasciitis on the Right Side of the Neck with Internal Jugular Vein Thrombophlebitis and Septic Emboli: A Case of Lemierre’s-Like Syndrome
Year: 2013
Copyright (license): CC BY 4.0
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Summary of article contents:
Introduction
Lemierre's syndrome (LS) is a rare but life-threatening condition often initiated by an oropharyngeal infection, leading to thrombophlebitis and metastatic abscesses, with a common causative organism being Fusobacterium necrophorum. Although LS typically affects younger, healthy adults, it can arise from other infections, including those in the abdomen. Despite aggressive treatment efforts, the disease carries a high morbidity rate. This case report discusses a 63-year-old male with uncontrolled diabetes presenting with Klebsiella pneumoniae-induced necrotizing fasciitis (NF) in the neck that progressed to LS.
Summary of One Important Concept: Necrotizing Fasciitis and Its Implications
Necrotizing fasciitis is a severe soft tissue infection characterized by rapid spread and extensive tissue necrosis, often requiring aggressive surgical intervention. This condition primarily occurs in immunocompromised individuals or those with underlying health issues, such as diabetes. The case report highlights NF stemming from a Klebsiella pneumoniae infection, which is less common compared to NF caused by other pathogens. The patient exhibited severe symptoms, including fever, chills, and lethargy, and diagnostic imaging revealed extensive necrotic tissue and thrombosis of the internal jugular vein. Effective management entails immediate broad-spectrum antibiotic therapy, surgical debridement, and supportive care to mitigate systemic effects, emphasizing the importance of early intervention.
Conclusion
The presented case exemplifies the critical need for medical professionals to maintain awareness of Lemierre's syndrome and its associations with infections like necrotizing fasciitis, particularly in patients with pre-existing conditions such as diabetes. Despite being a rare condition with an incidence of approximately 0.8–1.5 cases per million, timely diagnosis and treatment are vital in improving patient outcomes and reducing potential mortality. The findings call for vigilance in recognizing the signs of rapidly progressing infections and the necessity for urgent medical intervention to save lives in cases resembling Lemierre's syndrome.
FAQ section (important questions/answers):
What is Lemierre's syndrome and what causes it?
Lemierre's syndrome (LS) is a rare, life-threatening condition usually initiated by an oropharyngeal infection, leading to thrombophlebitis and metastatic abscesses. It is primarily caused by the bacteria Fusobacterium necrophorum, but can also occur due to other organisms, such as Klebsiella pneumoniae.
Who is most commonly affected by Lemierre's syndrome?
Lemierre's syndrome primarily affects young, healthy adults. However, it can also occur in individuals with underlying conditions, such as uncontrolled diabetes mellitus, making them more susceptible to the disease.
What are the symptoms of necrotizing fasciitis associated with LS?
Symptoms of necrotizing fasciitis may include severe pain, swelling, fever, and crepitus (a crackling sensation under the skin). Patients often show deterioration despite antibiotic treatments and may require immediate surgical intervention.
How is Lemierre's syndrome diagnosed and treated?
Diagnosis typically involves imaging studies like CT scans to identify thrombosis and abscesses. Treatment includes broad-spectrum intravenous antibiotics and urgent surgical debridement to remove necrotic tissue, followed by tailored antibiotic therapy based on culture results.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Necrotizing Fasciitis and Thrombophlebitis: Lemierre’s-Like Syndrome”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
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