Ophthalmic complications of Lemierre syndrome

Research output: Contribution to journalArticle

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 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.

Details

Authors
  • Robert Kreuzpointner
  • Luca Valerio
  • Gabriele Corsi
  • Federica Zane
  • Clara Sacco
  • Karin Holm
  • Christian Righini
  • Alessandro Pecci
  • Sandrine Zweifel
  • Stefano Barco
Organisations
External organisations
  • University Hospital of Zurich
  • Universitätsmedizin Mainz
  • St. Orsola-Malpighi University Hospital
  • Hospital of Sondrio
  • Humanitas Research Hospital
  • Skåne University Hospital
  • Grenoble University Hospital
  • Policlinico San Matteo Pavia Fondazione
  • University of Zurich
  • University of Bologna
  • University of Pavia
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Ophthalmology

Keywords

  • anticoagulation, bacterial infection, lemierre syndrome, mycotic aneurysm, ocular vein thrombosis, rare disorders
Original languageEnglish
JournalActa Ophthalmologica
Publication statusE-pub ahead of print - 2021
Publication categoryResearch
Peer-reviewedYes