Article
Lemierre's syndrome with intracerebral abscess
Lemierre-Syndrom – eine seltene Form intrazerebraler Abszesse
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Authors
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C.P.G. Heinen
- Neurochirurgie der Universität Ulm am BKH zu Günzburg
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T. Kretschmer
- Neurochirurgie der Universität Ulm am BKH zu Günzburg
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H.-P. Richter
- Neurochirurgie der Universität Ulm am BKH zu Günzburg
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W. Börm
- Neurochirurgische Klinik der Ev.-Luth. Diakonissenanstalt zu Flensburg
| Published: | May 8, 2006 |
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Outline
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Objective: Lemierre’s syndrome is a rarely occurring acute bacterial infection of the oropharynx with an incidence of 1 per million per year. The infection is caused by anaerobic bacteria of the Fusobacteria family and manifests mainly in primarily healthy youths and young adults. In most cases, the lungs and joints are affected and there is a risk of thrombophlebitis of the jugular veins. However, intracerebal abscesses may occur as well.
Methods: The first case was a 22-year-old woman who was admitted to our department showing progressive headache, reduced vigilance and meningism two weeks after a purulent tonsillitis. CCT revealed a frontotemporal abscess on the right side. A stereotactic abscess aspiration was performed, and cultures were positive for Fusobacterium nucleatum. Decompressing craniectomy one day later. Further CT scans depicted recurrent abscess formation and thus led to a BrainLab-guided biopsy, this time sterile cultures. The second patient was an 37-years old man who presented with a left-sided reactive edema. The first operation, a stereotactic punction, was performed on the of day admission. Fusobacterium naviforme was identified. After initially improvement the neurologic status deteriorated, therefore a second openly executed operation took place two weeks later. This time no germ could be found. In both cases no significant increase of inflammation parameters were observed. Antibiotic treatment in both consisted in Ceftriaxon and Metronidazol
Results: Both patients were successfully treated operatively and antibiotically. No other foci could be detected. The second microbiological exam showed no bacteria. According to literature early sterile reaccumulation of intracererbral abscess reflects a typical feature of Fusobacterium infection. At follow-up examination one patient had recovered completely, the other one showed improving skelasthenia.
Conclusions: Lemierre`s syndrom represents a severe and rare infection with occasional abscess formation in the brain. Although our scans for further foci turned out to be negative it is crucial to be aware of the high risk for infectious metastases.
