Metastatic complications of Fusobacterium necrophorum sepsis. Two cases of Lemierre's postanginal septicemia
L. C. Vogel and K. M. Boyer
We have recently encountered two instances of septicemia due to
Fusobacterium necrophorum in adolescents. The presence of severe exudative
pharyngitis in both patients pointed to the upper respiratory tract as the
probable portal of entry. In one case, metastatic infection was manifested
by multiple septic pulmonary emboli with associated pleural effusions. In
the other case, diffuse encephalopathy and septic arthritis of the left
shoulder and hip occurred. Unilateral neck pain, persistent bacteremia, and
prolonged fever despite appropriate antibiotics were consistent with the
presence of septic jugular thrombophlebitis in both patients. "Postanginal
septicemia" caused by F necrophorum, described by Lemierre in the
preantibiotic era, was undoubtedly the syndrome manifested by these
patients. This condition, formerly uniformly fatal, can readily be
diagnosed when anaerobic techniques are used for blood culture, but
requires prolonged antibiotic therapy for cure.
