Lemierre’s syndrome due to intratumoral abscess of the uvula
Lemierre’s syndrome (LS), described in detail in 1936, used to be a life-threatening entity until the advent of antibiotics. Tonsillitis or pharyngitis are the main primary infections and oropharyngeal anaerobic flora is the predominant etiology. However, other primary site infections, as well as ot...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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University of São Paulo
2015-09-01
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| Series: | Autopsy and Case Reports |
| Online Access: | http://www.revistas.usp.br/autopsy/article/view/107029 |
| _version_ | 1828405825509523456 |
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| author | Hassan Rahhal Fernando Peixoto Ferraz de Campos Cristiane Rubia Ferreira Aloísio Felipe-Silva |
| author_facet | Hassan Rahhal Fernando Peixoto Ferraz de Campos Cristiane Rubia Ferreira Aloísio Felipe-Silva |
| author_sort | Hassan Rahhal |
| collection | DOAJ |
| description | Lemierre’s syndrome (LS), described in detail in 1936, used to be a life-threatening entity until the advent of antibiotics. Tonsillitis or pharyngitis are the main primary infections and oropharyngeal anaerobic flora is the predominant etiology. However, other primary site infections, as well as other microbiological agents have been reported since the first description. Inflammatory symptoms in the neck and marked findings on physical examination predominate the majority of cases. Nonetheless, the authors report the case of a 54-year-old man with a history of dysphagia followed by cough, purulent expectoration, and fever. The bad condition of his dentition was noteworthy. During the diagnostic work-up, an ulcerated lesion in the uvula and a middle lobe pneumonia were disclosed. Streptococcus viridans was isolated from blood culture. On the fifth day of hospitalization, the patient died after a copious episode of hemoptysis. The autopsy findings depicted an abscess within a squamous cell carcinoma of the uvula, pharyngitis with carotid sheath spreading accompanied by pylephlebitis and thrombosis of the internal jugular vein up to the innominate vein, surrounded by an abscess in the mediastinum. Alveolar hemorrhage and pneumonia were also present. We conclude that the ulcerated carcinoma of the uvula housed an abscess, facilitated by the poor oral hygiene, which triggered LS and the descending mediastinitis. Pulmonary involvement was due to the septic embolism from the internal jugular vein. We would like to highlight the uvula abscess as the primary site of infection in this case of LS with S. viridans as the causative agent. |
| first_indexed | 2024-12-10T11:01:11Z |
| format | Article |
| id | doaj.art-0cb38bf652814d9aa0ad152622dcfc68 |
| institution | Directory Open Access Journal |
| issn | 2236-1960 |
| language | English |
| last_indexed | 2024-12-10T11:01:11Z |
| publishDate | 2015-09-01 |
| publisher | University of São Paulo |
| record_format | Article |
| series | Autopsy and Case Reports |
| spelling | doaj.art-0cb38bf652814d9aa0ad152622dcfc682022-12-22T01:51:41ZengUniversity of São PauloAutopsy and Case Reports2236-19602015-09-0153Lemierre’s syndrome due to intratumoral abscess of the uvulaHassan Rahhal0Fernando Peixoto Ferraz de Campos1Cristiane Rubia Ferreira2Aloísio Felipe-Silva3Department of Internal Medicine - Hospital das Clínicas - University of São Paulo, São Paulo/SPInternal Medicine Division - Hospital Universitário - University of São Paulo, São Paulo/SPAnatomy Pathology Service - Hospital Universitário - University of São Paulo, São Paulo/SPAnatomy Pathology Service - Hospital Universitário - University of São Paulo, São Paulo/SPLemierre’s syndrome (LS), described in detail in 1936, used to be a life-threatening entity until the advent of antibiotics. Tonsillitis or pharyngitis are the main primary infections and oropharyngeal anaerobic flora is the predominant etiology. However, other primary site infections, as well as other microbiological agents have been reported since the first description. Inflammatory symptoms in the neck and marked findings on physical examination predominate the majority of cases. Nonetheless, the authors report the case of a 54-year-old man with a history of dysphagia followed by cough, purulent expectoration, and fever. The bad condition of his dentition was noteworthy. During the diagnostic work-up, an ulcerated lesion in the uvula and a middle lobe pneumonia were disclosed. Streptococcus viridans was isolated from blood culture. On the fifth day of hospitalization, the patient died after a copious episode of hemoptysis. The autopsy findings depicted an abscess within a squamous cell carcinoma of the uvula, pharyngitis with carotid sheath spreading accompanied by pylephlebitis and thrombosis of the internal jugular vein up to the innominate vein, surrounded by an abscess in the mediastinum. Alveolar hemorrhage and pneumonia were also present. We conclude that the ulcerated carcinoma of the uvula housed an abscess, facilitated by the poor oral hygiene, which triggered LS and the descending mediastinitis. Pulmonary involvement was due to the septic embolism from the internal jugular vein. We would like to highlight the uvula abscess as the primary site of infection in this case of LS with S. viridans as the causative agent.http://www.revistas.usp.br/autopsy/article/view/107029 |
| spellingShingle | Hassan Rahhal Fernando Peixoto Ferraz de Campos Cristiane Rubia Ferreira Aloísio Felipe-Silva Lemierre’s syndrome due to intratumoral abscess of the uvula Autopsy and Case Reports |
| title | Lemierre’s syndrome due to intratumoral abscess of the uvula |
| title_full | Lemierre’s syndrome due to intratumoral abscess of the uvula |
| title_fullStr | Lemierre’s syndrome due to intratumoral abscess of the uvula |
| title_full_unstemmed | Lemierre’s syndrome due to intratumoral abscess of the uvula |
| title_short | Lemierre’s syndrome due to intratumoral abscess of the uvula |
| title_sort | lemierre s syndrome due to intratumoral abscess of the uvula |
| url | http://www.revistas.usp.br/autopsy/article/view/107029 |
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