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Ophthalmic complications of Lemierre syndrome

Kreuzpointner, Robert ; Valerio, Luca ; Corsi, Gabriele ; Zane, Federica ; Sacco, Clara ; Holm, Karin LU ; Righini, Christian ; Pecci, Alessandro ; Zweifel, Sandrine and Barco, Stefano (2022) In Acta Ophthalmologica 100(1).
Abstract

Purpose: Lemierre syndrome is a life-threatening condition characterized by head/neck bacterial infection, local suppurative thrombophlebitis and septic embolic complications in a range of sites of distant organs. No prior study focused on the course and characteristics of ophthalmic complications of Lemierre syndrome. Methods: We analysed data of 27 patients with ophthalmic complications from a large cohort of 712 cases with Lemierre syndrome reported globally between 2000 and 2017. We focused on initial manifestations, early (in-hospital) course and long-term ophthalmic deficits at the time of hospital discharge or during postdischarge follow-up. The study protocol was registered in the International Prospective Register of Systematic... (More)

Purpose: Lemierre syndrome is a life-threatening condition characterized by head/neck bacterial infection, local suppurative thrombophlebitis and septic embolic complications in a range of sites of distant organs. No prior study focused on the course and characteristics of ophthalmic complications of Lemierre syndrome. Methods: We analysed data of 27 patients with ophthalmic complications from a large cohort of 712 cases with Lemierre syndrome reported globally between 2000 and 2017. We focused on initial manifestations, early (in-hospital) course and long-term ophthalmic deficits at the time of hospital discharge or during postdischarge follow-up. The study protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO (CRD42016052572). Results: Nine (33%) patients were women; the median age was 20 (Q1–Q3: 15–33) years. Fusobacterium spp. was involved in 56% of cases. The most prevalent initial manifestations were decreased vision (35%) and periocular oedema (38%), followed by impaired eye movements/nerve palsy (28%) and proptosis (28%). Venous involvement, notably cerebral vein thrombosis (70%) and ophthalmic vein thrombosis (55%), explained the symptomatology in most cases. Septic embolism (7%), orbital abscesses (2%) and carotid stenosis (14%) were also present. Ophthalmic sequelae were reported in 9 (33%) patients, often consisting of blindness or reduced visual acuity, and nerve paralysis/paresis. Conclusion: Ophthalmic complications represent a severe manifestation of Lemierre syndrome, often reflecting an underlying cerebral vein thrombosis. Visual acuity loss and long-term severe complications are frequent. We call for an interdisciplinary approach to the management of patients with Lemierre syndrome and the routine involvement of ophthalmologists.

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author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
anticoagulation, bacterial infection, lemierre syndrome, mycotic aneurysm, ocular vein thrombosis, rare disorders
in
Acta Ophthalmologica
volume
100
issue
1
publisher
Wiley-Blackwell
external identifiers
  • pmid:33829646
  • scopus:85104006084
ISSN
1755-375X
DOI
10.1111/aos.14871
language
English
LU publication?
yes
id
311eab62-08e3-43e0-82c1-27e1cff0151c
date added to LUP
2021-04-23 06:50:19
date last changed
2024-03-23 03:40:15
@article{311eab62-08e3-43e0-82c1-27e1cff0151c,
  abstract     = {{<p>Purpose: Lemierre syndrome is a life-threatening condition characterized by head/neck bacterial infection, local suppurative thrombophlebitis and septic embolic complications in a range of sites of distant organs. No prior study focused on the course and characteristics of ophthalmic complications of Lemierre syndrome. Methods: We analysed data of 27 patients with ophthalmic complications from a large cohort of 712 cases with Lemierre syndrome reported globally between 2000 and 2017. We focused on initial manifestations, early (in-hospital) course and long-term ophthalmic deficits at the time of hospital discharge or during postdischarge follow-up. The study protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO (CRD42016052572). Results: Nine (33%) patients were women; the median age was 20 (Q1–Q3: 15–33) years. Fusobacterium spp. was involved in 56% of cases. The most prevalent initial manifestations were decreased vision (35%) and periocular oedema (38%), followed by impaired eye movements/nerve palsy (28%) and proptosis (28%). Venous involvement, notably cerebral vein thrombosis (70%) and ophthalmic vein thrombosis (55%), explained the symptomatology in most cases. Septic embolism (7%), orbital abscesses (2%) and carotid stenosis (14%) were also present. Ophthalmic sequelae were reported in 9 (33%) patients, often consisting of blindness or reduced visual acuity, and nerve paralysis/paresis. Conclusion: Ophthalmic complications represent a severe manifestation of Lemierre syndrome, often reflecting an underlying cerebral vein thrombosis. Visual acuity loss and long-term severe complications are frequent. We call for an interdisciplinary approach to the management of patients with Lemierre syndrome and the routine involvement of ophthalmologists.</p>}},
  author       = {{Kreuzpointner, Robert and Valerio, Luca and Corsi, Gabriele and Zane, Federica and Sacco, Clara and Holm, Karin and Righini, Christian and Pecci, Alessandro and Zweifel, Sandrine and Barco, Stefano}},
  issn         = {{1755-375X}},
  keywords     = {{anticoagulation; bacterial infection; lemierre syndrome; mycotic aneurysm; ocular vein thrombosis; rare disorders}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Acta Ophthalmologica}},
  title        = {{Ophthalmic complications of Lemierre syndrome}},
  url          = {{http://dx.doi.org/10.1111/aos.14871}},
  doi          = {{10.1111/aos.14871}},
  volume       = {{100}},
  year         = {{2022}},
}