Septic Thrombophlebitis Caused by Fusobacterium necrophorum in an Intravenous Drug User

Septic thrombophlebitis is characterized by venous thrombosis, inflammation and bacteremia, that can lead to fatal complications such as sepsis, septic emboli and even death. Though most commonly caused by indwelling catheters, it is also related to intravenous drug users (IVDU) especially those who attempt to inject drugs into more proximal and central veins. Lemierre’s syndrome, also referred to as post-anginal sepsis or necrobacillosis, is a suppurative thrombophlebitis of the internal jugular vein. Primary infection is associated with oropharyngeal and dental infections and the most common causative organism is Fusobacterium necrophorum. We report a case of Lemierre’s syndrome in an IVDU, caused by Fusobacterium necrophorum, which was inoculated at the site of injection, without a history of sore throat or pharyngitis. 1. Introduction Septic thrombophlebitis is characterized by venous thrombosis, inflammation, and bacteremia, that can lead to fatal complications such as sepsis, septic emboli, and even death [1]. Though most commonly caused by indwelling catheters, it is also related to intravenous drug users (IVDUs), especially those who attempt to inject drugs into more proximal and central veins [2]. The most frequent predominant pathogens of septic thrombophlebitis in IVDUs are Staphylococcus Aureus (MSSA or MRSA), followed by Streptococci species [1, 3]. Lemierre’s syndrome, also referred to as postanginal sepsis or necrobacillosis, is a suppurative thrombophlebitis of the internal jugular vein. Primary infection is associated with oropharyngeal and dental infections, and the most common causative organism is Fusobacterium necrophorum, which is part of human microflora of the oropharynx, genitourinary and gastrointestinal tracts. We report a case of Lemierre’s syndrome in an IVDU, caused by Fusobacterium necrophorum, which was inoculated at the site of injection, without a history of sore throat or pharyngitis. 2. Case Report A 31-year-old female presented to the emergency department of our hospital, complaining of high-grade fever with chills and shortness of breath while she had been well until two days earlier. She is refered with intravenous heroin use for more than fifteen years. The temperature was 39°C, the pulse rate was 95/min and the respirations were 25/min. Her physical examination revealed tenderness at the right site of the neck, redness and edema with mild regional lymphadenopathy (Figure 1). Examination of the oropharyngeal cavity, tonsils, and lungs was unremarkable. Nuchal rigidity was not noticed. One hour after admission, she