Liver abscessation and multiple septic pulmonary emboli associated with Lemierre’s syndrome: a case report

Yuichi Takano, Kenichiro Fukuda, Hiromi Takayasu, Kazuki Shinmura, Go Koizumi, Masahiro Sasai, Yoshikuni Nagayama, Michiari Kawamo, Tomohiro Yasuda, Kazumasa Watanabe, Jun Sasaki, Munetaka Hayashi, Eiichi Yamamura, Naotaka Maruoka, Masatsugu Nagahama, Hiroshi Takahashi

In Lemierre's syndrome, patients first exhibit pharyngitis and peritonsillar abscessation, followed by the development of anaerobic bacterial (usually Fusobacterium necrophorum) septicemia and metastatic infections throughout the body. However, these infections rarely affect the liver. We describe a case of Lemierre's syndrome, in which the first disease manifestation was liver abscess, for drawing attention of emergency physicians to this rare but fatal disease. A 28-year-old Asian ethnicity Filipino male, who was previously healthy, entered the emergency department presenting with fever and pharyngeal pain that had persisted for 5 days. Contrast-enhanced abdominal computed tomography revealed a 3-cm area of low density in segment 6 of the liver, consistent with an abscess. Chest computed tomography also revealed that multiple nodes in both lungs were enlarged, and septic emboli were suspected. The patient was hospitalized and antibiotic treatment was initiated. On hospital day 6, blood culture results confirmed Fusobacterium necrophorum septicemia. The patient was diagnosed with Lemierre's syndrome, as pharyngitis developed into bacteremia associated with hepatic and pulmonary lesions. The patient's condition improved with antibiotics and he was discharged following three weeks of treatment in the hospital. With the widespread use of antibiotics, Lemierre's syndrome is rarely encountered anymore, but it can be fatal if not properly diagnosed. It is a crucial differential diagnosis in young patients exhibiting septicemia or multiple metastatic infection of unknown origin.