A Unique Case of Lemierre Syndrome Caused by Streptococcus Constellatus Introduced by a Pharyngeal Injury

Nova Southeastern University, Davie, Florida, USA

Introduction. Lemierre Syndrome is a rare, potentially life-threatening infection that typically develops from invasion of bacteria through pharyngeal mucosal tissue, followed by septic thrombophlebitis, most often involving the internal jugular vein. Nearly 90 percent of cases are caused by Fusobacterum necrophorum. The current case describes Streptococcus constellatus, a component of the natural flora, as the causative agent of Lemierre syndrome. Case Presentation. A 40-year-old female presented with odynophagia, neck swelling, erythema and induration, as well as dysphonia and mild tenderness to palpation. Laryngoscopy showed serofibrinous debris and thickened secretions. CT scan of the neck showed a large fluid and gas collection originating from the left hypopharynx and extending into the left parapharyngeal region. The CT scan also showed focal narrowing of the left internal jugular vein with a flow void indicative of thrombus. Dissection in the deep tissues of the neck revealed purulent drainage that was sent for culture. The wound culture grew Streptococcus constellatus and the patient responded well to IV antibiotics. Deviation from the Expected. The present case describes an atypical causative agent for Lemierre syndrome: Streptococcus constellatus. Discussion. The pathogenesis of Lemierre Syndrome is complex and not well defined. What is known is that Fusobacteria necrophorum is the most common cause of Lemierre syndrome. Complications of this disease can be caused by dissemination of septic emboli which travel to major organs and cause damage. Accordingly, prompt diagnosis and treatment of Lemierre syndrome is critical to ensure improved patient outcomes. Conclusion. Despite only one other reported case of Streptococcus constellatus as the cause of Lemierre syndrome, it is important to identify this organism as a possible cause due to the severity of the disease without proper treatment.