A Lemierre-like syndrome caused by Staphylococcus aureus: an emerging disease

Abstract

Abstract Despite its clear definition, Lemierre’s syndrome is frequently used to describe any septic thrombophlebitis of the jugular vein. We report a Lemierre-like syndrome caused by Staphylococcus aureus without an oropharyngeal infection and present a systematic synthesis of reported cases to date of Lemierre-like syndrome caused by S. aureus. In addition to our case, 24 cases were found. In contrast to the classical picture, S. aureus is associated with an oropharyngeal infection in less than half of the cases. Another striking feature is the significant proportion of patients being very young and the fact that all 25 cases were published in the last 17\u2009years. S. aureus is a rare, but emerging cause of Lemierre-like syndrome. Adequate patient care rests on a high index of suspicion, prompt initiation of antibiotic therapy and early detection and management of metastatic abscesses. BULLET POINT SUMMARY The term Lemierre’s syndrome should be reserved for the classic triad of bacteraemia caused by anaerobic pathogens (primarily Fusobacterium necrophorum), evidence of internal jugular venous thrombosis, and a history of recent oropharyngeal infection. Similar syndromes not caused by anaerobic organisms or without history of an oropharyngeal infection should be named Lemierre-like syndrome and may be a more challenging diagnosis. Staphylococcus aureus is a cause of Lemierre-like syndrome, especially in very young children (<2 years old). The Staphylococcus aureus Lemierre-like syndrome is an emerging clinical syndrome. Adequate patient care is based on a high index of suspicion, prompt initiation of broad-spectrum antibiotics and active detection and management of metastatic abscesses.