SHM Converge Scientific Abstract ePoster Gallery-Lemierre's Syndrome Secondary to Metamizole-Induced Agranulocytosis

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This case describes a 77-year-old woman who developed severe infection and pancytopenia after taking over-the-counter metamizole (Analgin) for pain while traveling in Antigua. She presented with fever, sore throat, confusion, neck swelling, muffled voice, and stridor. Initial labs showed profound agranulocytosis (WBC 0.5, ANC 0.0) with pancytopenia. Peripheral smear showed atypical lymphocytes without neutrophils or blasts. Bone marrow biopsy later confirmed neutrophil aplasia, supporting drug-induced agranulocytosis.<br /><br />She was treated empirically with broad-spectrum antibiotics and required intubation for airway protection due to laryngeal edema. Blood cultures grew Serratia marcescens. After metamizole exposure was uncovered on medication reconciliation, hematology determined the marrow suppression was caused by the drug, and G-CSF was started. Her white count recovered after 7 days.<br /><br />Despite clinical improvement, persistent neck symptoms and pleural effusions prompted repeat imaging, which revealed cervical suppurative lymphadenitis and a nonocclusive right internal jugular vein thrombus, consistent with Lemierre’s syndrome. ENT performed incision and drainage of the neck abscess, and cultures again grew Serratia marcescens. Antibiotics were adjusted to aztreonam. Anticoagulation was deferred because the thrombus did not propagate and there was no ongoing septic embolization.<br /><br />The authors emphasize that Lemierre’s syndrome can present variably and lacks a universally accepted diagnostic definition. This case is unusual because the syndrome was secondary to metamizole-induced agranulocytosis, a potentially fatal adverse effect of a medication banned in many countries but still used elsewhere. The report highlights the importance of early imaging, prompt antibiotics, and careful medication history in patients with upper respiratory infections, neck involvement, or metastatic infection.

Asset Subtitle

Kevin Delfino

Meta Tag

Author List Antoun Kamel, Kevin Delfino, Mahmoud Mowafy

Category Clinical Vignettes

Concept Lemierre Syndrome

Concept Agranulocytosis

Concept Thrombophlebitis

Concept Metamizole

Concept Broad-Spectrum Antibiotic

Distinguished Non-Finalist

Presenter Organization Warren Alpert Medical School of Brown University, Providence, Rhode Island

Presenting Author Kevin Delfino

Track Adult

Keywords

metamizole

agranulocytosis

pancytopenia

Lemierre syndrome

Serratia marcescens

neutrophil aplasia

cervical suppurative lymphadenitis

internal jugular vein thrombus

G-CSF

drug-induced marrow suppression

Lemierre Syndrome

Agranulocytosis

Thrombophlebitis

Metamizole

Broad-Spectrum Antibiotic