SHM Converge Scientific Abstract ePoster Gallery-Lemierres Syndrome Complicated by Septic Arthtritis: A Challenging Manifestation

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This case describes a patient with <strong>Lemierre’s syndrome complicated by septic arthritis</strong>, emphasizing the importance of evaluating severe joint pain as a possible infected joint.

The patient initially presented to the ED with <strong>2 days of fever and odynophagia</strong>, without neck pain. Blood cultures grew <strong>gram-negative anaerobic bacteria</strong>, later identified as <strong>Fusobacterium species</strong>. A second ED visit led to admission, where CT neck/chest with contrast showed <strong>ill-defined hypoattenuation around the palatine tonsils</strong> and a <strong>partial filling defect in a venous branch arising from the internal jugular vein</strong>, consistent with Lemierre’s syndrome.

Soon after admission, the patient developed <strong>excruciating right hip pain</strong> and was unable to walk, prompting further evaluation. MRI of the spine/pelvis with contrast revealed <strong>periarticular bone marrow edema, irregular articular surfaces, an osseous erosion at the right sacroiliac joint, and a right hip effusion</strong>, concerning for <strong>septic arthritis</strong>.

Initial management included <strong>ceftriaxone and metronidazole</strong>. Because the patient improved clinically, surgical intervention was deferred. The patient later transferred from the MICU to the floor and was discharged on day 14 after being able to ambulate. Repeat CT neck on day 13 showed <strong>significant improvement</strong>. At outpatient follow-up on day 44, while taking <strong>amoxicillin-clavulanate</strong>, the patient’s <strong>right hip pain had completely resolved</strong>.

On admission, the patient was initially hypotensive and bradycardic, with notable lab abnormalities including <strong>elevated WBC, lactate, BUN, creatinine, and total bilirubin</strong>. This case highlights that in Lemierre’s syndrome, <strong>new severe joint pain should raise concern for septic arthritis</strong> and warrants prompt imaging and treatment.

Asset Subtitle

Yuka Shichijo

Meta Tag

Author List Alfred P. Burger, Bharati Dev, Lina Miyakawa, Matsuo So, Rostislav Gorbatov, Yuka Shichijo

Category Clinical Vignettes

Concept Lemierre Syndrome

Concept Internal Jugular Vein Thrombosis

Concept Septic Arthritis

Concept Fusobacterium

Concept Intravenous Antibiotics

Distinguished Non-Finalist

Presenter Organization Mount Sinai Beth Israel

Presenting Author Yuka Shichijo

Track Adult

Keywords

Lemierre syndrome

septic arthritis

Fusobacterium

internal jugular vein

odynophagia

gram-negative anaerobic bacteria

hip pain

MRI pelvis

ceftriaxone

metronidazole

Lemierre Syndrome

Internal Jugular Vein Thrombosis

Septic Arthritis

Fusobacterium

Intravenous Antibiotics