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Lemierre's syndrome due to Klebsiella pneumoniae in a 63-year-old man with diabetes: a case report.

Abstract

ABSTRACT:
INTRODUCTION
Lemierre's syndrome was originally documented to be caused by Fusobacterium necrophorum. It is a very rare condition with a prevalence of one to 14.4 instances per million. Its presentation is varied, not only in composition but also in the infecting organism. Treatment with anticoagulants has been controversial and applied only on a case-by-case basis.
CASE PRESENTATION
A 63-year-old Saudi man who had had uncontrolled diabetes mellitus for 47 years presented to our facility with a five-day history of swelling on the right side of his neck and fever. The swelling progressively increased in size and was associated with pain, dysphagia, odynophagia, change of voice ('hot potato voice'), and reduced appetite. Abscess content culture and sensitivity testing revealed Klebsiella pneumoniae. However, blood culture results were repeatedly negative. The abscess was incised and drained without any complication. Our patient was treated with clindamycin and cefuroxime. Warfarin was also administered concurrently for six weeks, for an isolated internal jugular vein thrombosis (IJV), with complete resolution of the thrombus. Normoglycemia was achieved and our patient was discharged after complete wound healing and the return of his biochemical parameters to normal.
CONCLUSIONS
Only two cases of Lemierre's syndrome in patients with diabetes due to K. pneumoniae have been reported previously. A review of the literature suggested that an association exists between deep neck infections due to K. pneumoniae and diabetes mellitus. The reasons for this association are still not clear. This poses a question as to whether diabetes mellitus specifically predisposes these patients to infection with this organism. It is suggested that clinicians should consider infectious agents other than F. necrophorum in the causation of Lemierre's syndrome, especially in patients with diabetes.

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    • Authors

    Garbati MA, Ahsan AM, Hakawi AM

    Institution

    Division of Infectious Diseases, Department of Medicine, King Fahad Medical City, 11525, Riyadh, Saudi Arabia. musagarbati@yahoo.com.

    Source

    Journal of medical case reports 6: 2012 pg 97

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22472458