Lemierre syndrome complicating otitis media caused by Streptococcus pneumoniae

A 34-year-old Asian male presented to our emergency department with fever, vomiting, and right ear pain for three days. He also reported ear discharge and right-sided neck pain. His past medical history was significant for extraskeletal Ewing sarcoma of gluteus muscle on chemotherapy (VAC protocol:Vincristine/Doxorubicin/Cyclophosphamide)and type 2 diabetes mellitus.On examination, he was febrile, and he had right-sided facial nerve palsy. Laboratory results were significant for elevated inflammatory markers. Computed tomography of temporal bone showed acute otitis media (AOM) features with filling defect in the right internal jugular vein. He was seen by an otolaryngologist who confirmed the diagnosis of AOM. Blood culture grew Streptococcus pneumoniae. The patient was started on intravenous ceftriaxone (2 g daily), and the fever subsided within 48 h. Magnetic resonance imaging (MRI) confirmed the diagnosis of right-sided labyrinthitis with secondary involvement of the right facial nerve and right jugular bulb thrombus (Fig. 1). Given the presence of otitis media, streptococcal bacteremia, and internal jugular vein thrombosis, Lemierre syndrome was diagnosed. On day 7, the patient was discharged with an intravenous ceftriaxone prescription for four weeks.

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Published in: IDCases
License: http://creativecommons.org/licenses/by/4.0/
See article on publisher's website: https://dx.doi.org/10.1016/j.idcr.2022.e01382