Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Sep 25, 2021; 10(5): 101-108
Published online Sep 25, 2021. doi: 10.5527/wjn.v10.i5.101
Lemierre's syndrome caused by Klebsiella pneumoniae: A case report
So Yeon Hwang, Seok Joon Shin, Hye Eun Yoon
So Yeon Hwang, Seok Joon Shin, Hye Eun Yoon, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, South Korea
Author contributions: Hwang SY reviewed the literature and contributed to manuscript drafting; Shin SJ and Yoon HE were responsible for the revision of the manuscript for important intellectual content; all authors approved the final version of the manuscript to be submitted.
Informed consent statement: Informed consent was obtained from the patients and their caregivers. The images were published in agreement with the patient.
Conflict-of-interest statement: None of the authors have any financial or other conflicts of interest to declare with regard to this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Seok Joon Shin, MD, PhD, Full Professor, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsuro, Bupyeong-Gu, Incheon 21431, South Korea. imkidney@catholic.ac.kr
Received: April 24, 2021
Peer-review started: April 24, 2021
First decision: June 6, 2021
Revised: June 19, 2021
Accepted: July 30, 2021
Article in press: July 30, 2021
Published online: September 25, 2021
Processing time: 154 Days and 11 Hours
Abstract
BACKGROUND

Lemierre's syndrome is a disease that causes anaerobic sepsis, internal jugular vein thrombosis, and septic embolism in the lungs and other organs after acute oropharyngeal infection. It was named after André-Alfred Lemierre in 1936.

CASE SUMMARY

Here, we have reported a case of Lemierre’s syndrome in a 56-year-old female patient who presented with a sore throat. The patient had septic shock, had not voided, and had severe hyperglycemia at the time of her visit. Imaging tests revealed bilateral pneumonia, pleural effusion, pulmonary embolism, and renal vein thrombosis. The patient was admitted to the intensive care unit and placed on mechanical ventilation due to acute respiratory distress syndrome. Continuous renal replacement therapy was administered to treat renal failure with anuria. Klebsiella pneumoniae was cultured from blood and sputum samples. After reviewing various results, the patient was ultimately diagnosed with Lemierre’s syndrome. The patient was treated with appropriate antibiotics and thrombolytic agents. She was discharged from the hospital after recovery.

CONCLUSION

Lemierre’s syndrome is associated with a high mortality rate. Therefore, clinicians should be familiar with the signs and symptoms of this disease as well as the preemptive examinations, procedures, and treatments.

Keywords: Lemierre's syndrome; Klebsiella pneumoniae; Diabetes Mellitus; Pulmonary embolism; Septic pneumonia; Case report

Core Tip: Lemierre’s syndrome is mostly caused by Fusobacterium. However, we present a rare case of Lemierre’s syndrome caused by Klebsiella pneumoniae in a patient with poor glycemic control. Uncommon in Lemierre’s syndrome, renal vein thrombosis and acute kidney injury occurred, continuous renal replacement therapy was performed, and mechanical ventilation was performed for serious pulmonary complications. The incidence of Lemierre's syndrome decreased after antibiotics were developed. However, when Lemierre’s syndrome occurs, the mortality rate from its complications is high, so we want to emphasize that patients with systemic symptoms accompanied by fever and sore throat should be suspicious of Lemierre's syndrome.