SHM Converge Scientific Abstract ePoster Gallery-Fusobacterium Necrophorum, Not Just a Pain in the Neck

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A healthy 22-year-old man presented with 4 days of acute vomiting, fever, jaundice, hypotension, and tachycardia after eating fried chicken and rice. He denied sore throat, cough, neck pain or stiffness, rash, photophobia, or abdominal pain. Exam showed an ill-appearing patient with scleral icterus but no neck findings, tonsillar exudates, rash, or abdominal tenderness.<br /><br />Laboratory testing showed jaundice with elevated total and direct bilirubin and alkaline phosphatase, while AST and ALT were normal. HIV testing was negative. CT imaging of the abdomen and pelvis revealed peripheral hepatic vein thrombosis, suggesting septic thrombophlebitis in an unusual location.<br /><br />The patient improved with empiric piperacillin/tazobactam and was later changed to ampicillin/sulbactam after culture results. He was discharged on oral amoxicillin-clavulanate to complete a 14-day antibiotic course. Follow-up labs showed resolution of bicytopenia.<br /><br />The key teaching point is that Fusobacterium necrophorum, an anaerobic gram-negative rod normally found in the alimentary and female genitourinary tracts, is best known for causing Lemierre’s syndrome, typically after an oropharyngeal infection with internal jugular vein septic thrombophlebitis. However, this case highlights that Fusobacterium necrophorum can also cause thrombophlebitis in other locations, such as the hepatic veins, even without classic throat or neck symptoms.

Asset Subtitle

Audrey Liu

Meta Tag

Author List Audrey Liu, Jared S. Honigman Do

Category Clinical Vignettes

Concept Fusobacterium necrophorum

Concept Septic Thrombophlebitis

Concept Lemierre Syndrome

Concept Thrombophlebitis

Concept Internal Jugular Vein

Distinguished Non-Finalist

Presenter Organization Zucker SOM Internal Medicine Residency at NS/LIJ

Presenting Author Audrey Liu

Track Adult

Keywords

Fusobacterium necrophorum

Lemierre syndrome

hepatic vein thrombosis

septic thrombophlebitis

jaundice

bicytopenia

anaerobic gram-negative rod

piperacillin-tazobactam

ampicillin-sulbactam

amoxicillin-clavulanate

Fusobacterium necrophorum

Septic Thrombophlebitis

Lemierre Syndrome

Thrombophlebitis

Internal Jugular Vein