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The use of medical eponyms is widespread across hospital wards and
medical school halls worldwide, and it clearly indicates that the
history of medicine is much more than an arid catalogue of discoveries.
It is estimated that more than 8,000 medical eponyms
exist1, and a certain degree of debate has been
recently generated on eponyms being potentially archaic and
scientifically misleading despite being of undoubted fascination as they
embed different medical traditions and cultures2. At
the intersection of otolaryngology, infectious disease and vascular
surgery, Lemierre Syndrome (LS) was first described by Andre Lemierre in
1936 as ‘anaerobic postanginal sepsis’, consisting of septic
thrombophlebitis of the internal jugular vein secondary to uncontrolled
oropharyngeal infection by Fusobacteriumspecies3.
In this issue of the Journal, Morishige and
colleagues4 reported the case of an uncommon variant
of this rare syndromic disease, which has an annual incidence of 3.6
cases per million people in its classic presentation5.
The Authors presented a case which stood out under multiple standpoints:
- First, the pathophysiology was unique. They presented a case of
infective endocarditis secondary to thrombophlebitis in the left
vertebral vein which was secondary to pharyngitis caused by
methicillin-sensitive Staphylococcus Aureus . They identified
this condition as a rare LS variant. Interestingly, the primary focus
of infection had spread to the left ventricular wall and created a
pedunculated, encapsulated, purulent abscess attached to the
trabeculae carnae of the anterior ventricular wall. Additional
eponymic signs of systemic septic embolization were appreciated,
namely Osler nodes (painful, red, raised lesions on extremities) and
Janeway lesions (non-tender, small haemorrhagic lesions on the palms
and soles), but not Roth-Litten spots (small, white-centered retinal
hemorrhages) – all of which may be typical in patients with infective
endocarditis.
- Secondly, the decision-making process for optimal treatment was
multidisciplinary, as suggested by the guidelines on infective
endocarditis6. The Authors had cardiologists,
infectious diseases physicians and neurologists involved in rapidly
assessing the patient pre-operatively and ruling out potential
contraindications to early surgery such as embolic
stroke7. Notably, the patient was neurologically
compromised at presentation with acute cerebral and cerebellar
dysfunction and a Glasgow Coma Scale of 7. However, after careful
evaluation of the size (<10 mm) and locations (frontal
cortex, caudate nucleus, and left cerebellar hemisphere) of the
hyperdense lesions at brain magnetic resonance imaging, the neurologic
status was mainly attributed to sepsis–associated encephalopathy
rather than septic embolization, thus allowing for prompt surgical
control of the infective source.
- Finally, the outcome was excellent. The patient underwent early
surgery (transseptal abscess excision) followed by long-term
antimicrobial therapy to control the primary source of infection and
anticoagulation therapy to prevent left vertebral vein
thrombophlebitis from recurring, with complete normalization of
neurologic status at discharge and no relapsing at latest follow-up.
In conclusion, Morishige and colleagues must be congratulated for their
comprehensive, collaborative, multidisciplinary efforts which led to the
successful treatment of a rare and highly comorbid syndromic condition.