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Brief Reports: Miranda D. Lu, Zubin Vasavada, and Christina Tanner Lemierre Syndrome Following Oropharyngeal Infection: A Case Series J Am Board Fam Med 2009; 22: 79-83 [Abstract] [Full text] [PDF]

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Radiologists beware

ANN L. JOBB   (23 January 2009)

Radiologists beware 23 January 2009
ANN L. JOBB, Medical Coder/Transcriptionist RML Specialty Hospital Send response to journal: Re: Radiologists beware annjobb{at}hotmail.com ANN L. JOBB	My son was diagnosed with Lemierre's syndrome in May, 2006, but fortunately never developed any pulmonary emboli. Unfortunately, the radiologists at our local hospital did not catch the internal jugular embolism, and attributed their not seeing it to "compression" of the vessel. While it's essential that pediatricians and family practice docs get the appropriate information and warnings, as the incidence for this condition is on the upswing, it is also imperative that ALL physicians involved, as well as the RN's treating the patient in the hospital, receive this information. I went to Northwestern University Hospital in Chicago as a last resort, as Jon still had complete occlusion of his IJ six months after the onset. He did form collaterals eventually, and has been healthy since then (after a full six months of recovery!). The swelling in the neck did take a full year to go away, however. IF the radiologists were better informed as to what to look for with this disease, Jon probably could have been anticoagulated and the clot could has dissipated, or maybe not. Either way, the point is that all clinicians should be better educated about this life-threatening illness. Not one nurse who attended him in the hospital ever heard of it, and I was the one to educate them about it. The second point that I would like to make is to NEVER dismiss what your child is telling you, especially if it's a persistent complaint. Jon had some allergy testing done the day before his 106 fever brought him to the ER. The MD looked at his 'sore neck' and saw absolutely nothing. We tried every test available to find out the cause of his malaise, on and off fevers, and 'sore neck', but all were negative - classic for Lemierre's. Looking back at photos taken a few days before the ER, his neck was already quite swollen on that side, but not so much that it was noticeable to the physicians, or even me. It's imperative to listen CAREFULLY and SPECIFICALLY to what the child is telling you. Going through this was very scary for us, and we are thankful for a positive outcome. It's interesting that more and more information is currently available regarding this illness, which was not available two years ago. I queried the ID doc on call at my hospital the day of Jon's admission, and his reaction scared the heck out of me! The illness was not even listed in my coding books, but has since been listed - more evidence that this is around to stay. Thanks for the forum. Feel free to ask me any questions down the road.