gms | German Medical Science

Introduction: Oropharyngeal infections with complication like a peritonsillar abszess are a typical clinical case in the daily practice of an otorhinolaryngologist. Rarely they appear in combinations with hereditary predisposition. We want to present one of these cases.

Case: The patient applied to our clinic with temperature at 44°C with acute thoracic ache provoked by respiration. She has had sore throat during the last week. In the examination there was especially no sign of a PTA. In labatory tests a leukopenia (2.3 Gpt/l) and thrombocytopenia (48 Gpt/l) were dectected. The PCT was at 98.7 ng/ml.

Because of the difference between the clinical picture and the diagnostic findings we decided to undertake a computer tomography of the neck/throat/abdomen.

A PTA in the left tonsil was visible on the scale of 8mm, also a jugular vein thrombosis and multiple septic emboli were detected. We conducted a tonsillectomy.

Furthermore we initated and calculated antbiosis and a full dose heparinization. Blood culture exposed Fusobacterium necrophorum and staphylococcus warnei.

We assumed a thrombotic predisposition because of the decribed clinical constellation. There appeared a positive family history and clinical proof in labatory test on our patient for Protein-C-deficit. Therefore a thrombophilia was detected.

Discussion: The synopsis of all diagnostic findings in our case is conformable to the lemierre-syndrom. The incidence rate of lemierre-syndrom is 14.4/1 Mio at the age of 15–24 years [1]. Only few cases demonstrate a connection between lemierre-syndrom and thrombophilia. To date a deficit of factor V [2] and other rare genetic changes in the coagulation system are proved [3]. In our case there was a labatory confirmed Protein-C deficit. Protein-C is a protease and a lack of it lead to a thrombophilia. Additional she took a contraceptive pill.

Conclusion: We concluded that a interference in the coagulation system has to be eliminated when there is a young person with discrepancy of local clinical findings and a servere clinical picture.