Letter to the Editor

Lemierre Syndrome Caused by Group C Streptococci and Associated with Red Cell Aplasia and Immune Thrombocytopenia

Authors: Prerna Mewawalla, MD, Frank Bauer, MD, Constantin A. Dasanu, MD, PhD

Abstract

To the Editor:


We read with great interest the article by Tran et al1 on Lemierre syndrome, a rare condition first described in 1936 by the French bacteriologist André Alfred Lemierre, which has perpetually intrigued and perplexed many generations of clinicians worldwide ever since. The authors make a valid point in suggesting that this disease affects predominantly young and healthy adults. They present a classic case of Lemierre syndrome caused by Fusobacterium necrophorum in a healthy young patient, and caution the medical community about the rapid and potentially fatal deterioration which will result unless appropriate antibiotics are received in a timely manner. We report herein the first case of Lemierre syndrome caused by beta-hemolytic group C streptococci. Other unique features in our case are acute self-limited forms of immune thrombocytopenia and red cell aplasia, probably via an autoantibody mechanism triggered by the infectious process.

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References

1. Tran D, Maradia K, Montero J. Lemierre syndrome: a rare disease affecting previously healthy, young individuals. South Med J 2010;103:1190.
 
2. Sinave CP, Hardy GJ, Fardy PW. The Lemierre syndrome: suppurative thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection. Medicine (Baltimore) 1989;68:85–94.
 
3. Harris CM, Johnikin M, Rhodes H, et al. Lemierre's syndrome resulting from streptococcal induced otitis media and mastoiditis: a case report. J Med Case Reports 2009;3:6658.
 
4. Centor RM. Expand the pharyngitis paradigm for adolescents and young adults. Ann Intern Med 2009;151:812–815.
 
5. Zwart S, Sachs AP, Ruijs GJ, et al. Penicillin for acute sore throat: randomized double blind trial of seven days versus three days treatment or placebo in adults. BMJ 2000;320:150–154.