warfarin and Pharyngitis

An increasingly reported entity, Lemierre's syndrome classically presents with a recent oropharyngeal infection, internal jugular vein thrombosis and the presence of anaerobic organisms such as Fusobacterium necrophorum. The authors report a normally fit and well 17-year-old boy who presented with severe sepsis following a 5-day history of a sore throat, myalgia and neck stiffness requiring intensive care admission. Blood cultures grew F. necrophorum and radiological investigations demonstrated left internal jugular vein, cavernous sinus and sigmoid sinus thrombus, left vertebral artery dissection and thrombus within the left internal carotid artery. Imaging also revealed two areas of acute ischaemia in the brain, consistent with septic emboli, skull base (clival) osteomyelitis and an extensive epidural abscess. The patient improved on meropenem and metronidazole and was warfarinised for his cavernous sinus thrombosis. He has an on-going left-sided hypoglossal (XIIth) nerve palsy.

Topics: Adolescent; Anti-Infective Agents; Anticoagulants; Cranial Fossa, Posterior; Fever; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Hypoglossal Nerve Diseases; Jugular Veins; Lemierre Syndrome; Male; Meropenem; Metronidazole; Osteomyelitis; Pharyngitis; Sepsis; Thienamycins; Treatment Outcome; Warfarin

Topics: Aspirin; Drug Interactions; Hematoma; Humans; Laryngoscopy; Male; Middle Aged; Mouth Diseases; Pharyngitis; Warfarin

With the increase in the number of patients undergoing warfarin therapy, reports of complications due to such therapy have become frequent. Although upper airway obstruction secondary to bleeding resulting from warfarin therapy is rare, it is a life-threatening complication because of the risk of airway obstruction. Only one previous case of hematoma of the epiglottis and arytenoids has been reported. We here in report a case of an 83-year-old woman on warfarin therapy who presented with a sore throat. On flexible nasoendoscopy, edema of the epiglottis and bilateral arytenoids with a red and purple hue were observed. The left true vocal cord was erythematous, but the airway was adequately maintained. The PT-INR of the patient was 10. She was managed conservatively and had a good course.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Arytenoid Cartilage; Cefazolin; Epiglottis; Female; Fibrinolytic Agents; Hematoma; Humans; Hydrocortisone; Infusions, Intravenous; Nasal Obstruction; Pharyngitis; Warfarin