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Hey #MedTwitter! Your teenage patient w/ a sore throat suddenly develops rigors & shortness of breath--yikes! What is going on? Read this #tweetorial teaser in honor of MY FIRST @TheCribsiders episode on #pediatric #pharyngitis featuring the one & only Dr. Centor @MedRants 1/8
To start, what is #LemierresSyndrome? A septic thrombophlebitis of the internal jugular vein, often preceded by bacterial pharyngitis. Which bacteria is the predominantly causative organism? 2/8
The bacteria #Fusobacterium is the classic causative pathogen of Lemierre's Syndrome (not Lumiere's 
). Fuso is an aggressive anaerobic bacteria. 3/8
). Fuso is an aggressive anaerobic bacteria. 3/8
#ClinicalPresentation: Lemierreâs is generally seen in ages 16-30. A classic patient is a teen who has a high #CentorScore but has a negative rapid & culture for GAS ; they will look VERY SICK. Untreated, the patient doesnât improve & in fact worsens [see text below]. 4/8
![#ClinicalPresentation: Lemierreâs is generally seen in ages 16-30. A classic patient is a teen who has a high #CentorScore but has a negative rapid & culture for GAS ; they will look VERY SICK. Untreated, the patient doesnât improve & in fact worsens [see text below]. 4/8](https://pbs.twimg.com/media/EfkvxgjWAAIqU-b.png "#ClinicalPresentation: Lemierreâs is generally seen in ages 16-30. A classic patient is a teen who has a high #CentorScore but has a negative rapid & culture for GAS ; they will look VERY SICK. Untreated, the patient doesnât improve & in fact worsens [see text below]. 4/8")
#Complications: Septic emboli from the Internal jugular vein commonly cause severe pulmonary emboli, making #respiratory symptoms & complications key in these patients. Septic emboli can also travel & affect other organs. 5/8
https://www.nejm.org/doi/pdf/10.1056/ENEJMicm030003
https://www.nejm.org/doi/pdf/10.1056/ENEJMicm030003
#Treatment: Bc Lemierre's is rare (but less rare than ARF: @acp https://www.acpjournals.org/doi/abs/10.7326/0003-4819-151-11-200912010-00011?journalCode=aim), no guidelines exist at this time. What do we know? Most Fuso are sensitive to penicillins, & most hospitalized patients are treated w/ pip-tazo. The role of #anticoagulation is unclear. 6/8
#Summary: Know the #RedFlags for #Lemierres: 1. Rigors 2. Unilateral Neck Swelling 3. Pulmonary Symptoms 4. No improvement after 5-6 days. #Pediatric #FamilyMed #MedPeds & #IM colleagues, always consider Lemierreâs in your previously healthy young adult/teen patients! 7/8
And don't forget to take a listen to our #Pediatric #Pharyngitis
@TheCribsiders episode featuring @medrants debuting WED 8/19! Let me know what you liked, learned, or want to hear more of! Special thanks to @medrants for content & @justinberk for #tweetorial mentorship! 8/8
@TheCribsiders episode featuring @medrants debuting WED 8/19! Let me know what you liked, learned, or want to hear more of! Special thanks to @medrants for content & @justinberk for #tweetorial mentorship! 8/8
