2024 American Academy of Neurology Abstract Website

Objective:

To describe an incidence of Lemierre syndrome due to blastomycosis, a rarely implicated pathogen.

Background:

Diagnosis of Lemierre syndrome requires the combination of a head or neck infection, radiographic evidence of thrombosis or thrombophlebitis of the internal jugular vein, and isolation of a causative pathogen. Typically, the isolated pathogen is Fusobacterium necrophorum; however, any pathogen causing oropharyngeal infection can result in the syndrome. Consideration of alternative pathogens including fungal organisms is necessary for prompt diagnosis and treatment.

Design/Methods:

N/A

Results:

A 28-year-old female with recurrent ear infections presented with neck pain and hearing loss. The patient endorsed five months of neck pain and one month of left ear pain, ringing, and vertigo. Her exam demonstrated decreased hearing in the left ear and retro-auricular tenderness.

MRI brain showed occlusion of the left internal jugular vein and left sigmoid and transverse sinuses, and otomastoiditis and osteomyelitis of the C1 vertebral body, occipital condyles, and base of the skull and soft tissue abscess formation. CT Chest demonstrated diffuse pulmonary opacities consistent with multifocal pneumonia. Neck abscess biopsy demonstrated non-caseating granulomas and thick-walled budding yeasts consistent with Blastomycoses.

The patient’s course was complicated by intubation and initiation of extracorporeal membrane oxygenation for ARDS. The patient was started on antifungal therapy; therapeutic anticoagulation due to underlying septic thrombophlebitis. The patient improved clinically and was ultimately discharged on long-term antifungal therapy.

The case describes Lemierre syndrome due to blastomycosis, a rarely implicated organism. Prompt diagnosis is essential for prevention of neurologic and systemic complications. The case demonstrates clinicians must maintain a broad differential when managing septic thrombophlebitis involving the cerebral venous system, and consider fungal causes in the appropriate clinical context.

Conclusions:

When encountering septic thrombophlebitis of the internal jugular vein, fungal organisms including blastomycosis should be considered during workup and management.