SHM Converge Scientific Abstract ePoster Gallery-Fusobacterium Necroforum Bacteremia Without Jugular Venous Thrombophlebitis

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This case report describes a 53-year-old man with no significant past history who presented with 6 days of fever and back pain. He had no sore throat or cough, but was tachycardic, febrile, and showed signs of systemic infection. Initial chest CT revealed a right upper lobe mass with a reversed halo sign, which later developed cavitation and bilateral pleural effusions. Abdominal CT showed a liver abscess and portal vein thrombosis. Gram staining of peripheral blood demonstrated gram-negative rods, and the infection was identified as <em>Fusobacterium necrophorum</em> bacteremia.

The patient’s course was complicated by lung abscess, bilateral empyema requiring thoracic drainage and video-assisted thoracic surgery, and drainage of the liver abscess. He was treated with antibiotics including ceftriaxone, sulbactam/ampicillin, and metronidazole, with improvement.

The report emphasizes that <em>F. necrophorum</em> is classically linked to pharyngotonsillitis and Lemierre’s syndrome, which typically includes internal jugular venous thrombophlebitis and metastatic pulmonary abscesses. However, atypical invasive infections can occur without jugular thrombophlebitis or obvious neck infection. According to prior studies, about 30% of <em>F. necrophorum</em> bacteremia cases lack a neck source, and these patients may be older and have different comorbidities. Pulmonary involvement and empyema are less common in such cases, but mortality may be higher than in classic Lemierre’s syndrome.

The authors conclude that disseminated <em>F. necrophorum</em> infection can present without the usual signs of Lemierre’s syndrome, and clinicians should maintain a high index of suspicion for early diagnosis and treatment.

Asset Subtitle

Yoshitaka Tomoda

Meta Tag

Author List Kenji Motohashi, Kohei Ukai, Naoki Wasai, Satoshi Kitaura, Yoshitaka Tomoda, Yusuke Yasumoto

Category Clinical Vignettes

Concept Fusobacterium necrophorum

Concept Disseminated infection

Concept Lemierre Syndrome

Concept Bacteremia

Concept Jugular vein thrombophlebitis

Distinguished Non-Finalist

Presenter Organization Itabashi Chuo Medical Center

Presenting Author Yoshitaka Tomoda

Track Adult

Keywords

Fusobacterium necrophorum

bacteremia

Lemierre syndrome

lung abscess

liver abscess

empyema

portal vein thrombosis

reversed halo sign

thoracic drainage

metronidazole

Fusobacterium necrophorum

Disseminated infection

Lemierre Syndrome

Bacteremia

Jugular vein thrombophlebitis