acenocoumarol and Bacteremia

Lemierre's syndrome is a potentially fatal disease that usually presents with oropharyngeal infection, followed by sepsis, thrombosis of the internal jugular vein and septic emboli. Most cases are caused by the Gram-negative, anaerobic Fusobacterium necrophorum. We present two patients with an atypical presentation of Lemierre's syndrome and a review. These cases illustrate that a positive blood culture for F. necrophorum, even without the presence of clinical symptoms pointing towards thrombosis of the internal jugular vein, justifies further radiological testing for thrombophlebitis of the internal jugular vein.

Topics: Acenocoumarol; Anti-Bacterial Agents; Anticoagulants; Bacteremia; Deglutition Disorders; Diarrhea; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Jugular Veins; Male; Middle Aged; Nadroparin; Penicillins; Pharyngitis; Pneumonia, Bacterial; Syndrome; Thrombophlebitis; Ultrasonography; Young Adult

Pylephlebitis is the septic thrombosis of the portal vein. Hypercoagulability and intra-abdominal sepsis are the main predisposing factors. A 25-year-old man presented to a primary health care center complaining of fever, epigastric pain, and jaundice. He was initially diagnosed with a gastrointestinal infection and alcoholic hepatitis and, due to his unstable clinical status, was referred to the emergency room. A diagnosis of acute pylephlebitis complicated with septic shock was made. Treatment with a wide-spectrum antibiotic and anticoagulation was initiated. Fifteen days later, recanalization of the portal vein was achieved and clinical status was improved. Pylephlebitis following gastrointestinal infection is a potential cause of septic shock.

Topics: Acenocoumarol; Acute Disease; Adult; Anti-Bacterial Agents; Anticoagulants; Bacteremia; Escherichia coli Infections; Heparin; Humans; Jaundice; Male; Phlebitis; Portal Vein; Radiography; Shock, Septic; Ultrasonography; Venous Thrombosis