SHM Converge Scientific Abstract ePoster Gallery-Severe Thrombocytopenia in a Case of Lemierre's Syndrome

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This case describes a 36-year-old man with Lemierre’s syndrome caused by <strong>Fusobacterium necrophorum</strong>, presenting after a sore throat and neck pain with <strong>right internal jugular vein thrombosis</strong>, deep neck infection, and lung nodules. He had <strong>extreme thrombocytopenia</strong> on admission (platelets 7,000/µL), which persisted despite platelet transfusions.

Because his thrombocytopenia did not respond to treatment and later he developed <strong>hemolysis</strong> with anemia, elevated LDH, low haptoglobin, and schistocytes, clinicians initially suspected <strong>immune thrombocytopenia (ITP)</strong> and then <strong>thrombotic thrombocytopenic purpura (TTP)</strong>. His <strong>PLASMIC score was 6</strong>, suggesting high risk for severe ADAMTS13 deficiency, so plasma exchange and steroids were started. However, his <strong>ADAMTS13 level was only mildly reduced (57%)</strong>, making TTP unlikely.

Blood cultures grew <strong>Fusobacterium necrophorum</strong>, and with continued antibiotic therapy, his <strong>platelet count, white blood cell count, and anemia improved</strong>, supporting the infection as the underlying cause. The authors conclude that the most likely explanation for the severe thrombocytopenia and hemolysis was <strong>an intrinsic effect of Fusobacterium</strong>, possibly through platelet aggregation and hemolysin production.

Key takeaways:
- Lemierre’s syndrome can be complicated by <strong>severe thrombocytopenia</strong> and <strong>hemolytic anemia</strong>.
- Fusobacterium infections may directly contribute to these hematologic abnormalities.
- In Lemierre’s syndrome, the <strong>PLASMIC score may have reduced specificity</strong> for diagnosing TTP.

Asset Subtitle

Ian G. Waters

Meta Tag

Author List Ian G. Waters, Rebecca L. Wilson

Category Clinical Vignettes

Concept Lemierre Syndrome

Concept Septic Thrombophlebitis

Concept Fusobacterium

Concept Fusobacterium necrophorum

Concept Internal Jugular Vein

Distinguished Non-Finalist

Presenter Organization University of Chicago Pritzker School of Medicine

Presenting Author Ian G. Waters

Track Adult

Keywords

Lemierre syndrome

Fusobacterium necrophorum

internal jugular vein thrombosis

deep neck infection

extreme thrombocytopenia

hemolysis

thrombotic thrombocytopenic purpura

PLASMIC score

ADAMTS13

platelet aggregation

Lemierre Syndrome

Septic Thrombophlebitis

Fusobacterium

Fusobacterium necrophorum

Internal Jugular Vein