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Differential diagnosis of Lemierre's syndrome in a patient with acute paresis of the abducens and oculomotor nerves

Andreas Gutzeit, Justus E Roos, Bettina Portocarrero Vivero-Fäh, Carolin Reischauer, Lulian Claas, Karin Gassmann, Klaus Hergan, Sebastian Kos, Biliana Rodic, Kerstin Winkler, Urs Karrer & Sabine Sartoretti-Schefer

abstract Lemierre's syndrome is characterized by anaerobic septicemia, internal jugular vein thrombosis, and septic emboli associated with infections of the head and neck. We describe an unusual and clinically confusing case of a young woman with an acute paresis of the abducens nerve and partial paresis of the right oculomotor nerve. After an extensive imaging diagnostic procedure, we also documented a peritonsillar abscess and various types of thromboses in intracranial and extracranial veins. Furthermore, we found brain and lung abscesses, which led us to establish the diagnosis of Lemierre's syndrome. Despite intensive anti-coagulation and antibiotic therapy, the patient developed a mycotic aneurysm in the right internal carotid artery directly adjacent to the previously thrombosed cavernous sinus. In summary, we were able to confirm that Lemierre's syndrome may occur in conjunction with uncharacteristic symptoms. Due to the sometimes confusing clinical symptoms as well as clinical and radiological specialties, we had to work on an interdisciplinary basis to minimize the delay prior to establishing the diagnosis and therapy.
   
citation Gutzeit A, Roos J E, Portocarrero Vivero-Fäh B, Reischauer C, Claas L, Gassmann K, Hergan K, Kos S, Rodic B, Winkler K, Karrer U, Sartoretti-Schefer S. Differential diagnosis of Lemierre's syndrome in a patient with acute paresis of the abducens and oculomotor nerves. Korean J Ophthalmol 2013; 27:219-23.
   
type journal paper/review (English)
date of publishing 23-05-2013
journal title Korean J Ophthalmol (27/3)
ISSN print 1011-8942
pages 219-23
PubMed 23730118
DOI 10.3341/kjo.2013.27.3.219