[Lemierre's post-tonsillitis sepsis with meningitis and intravascular consumption coagulopathy as complication of infectious mononucleosis with pansinusitis]

Dtsch Med Wochenschr. 1996 Jan 26;121(4):94-8. doi: 10.1055/s-2008-1042978.
[Article in German]


History and clinical findings: 24 days after the onset of infectious mononucleosis, clinically and serologically confirmed, an otherwise healthy 18-year-old schoolboy developed a fulminant septicaemia with acute meningitis and loss of consciousness, consumptive coagulopathy and acute renal failure.

Investigations: Computed tomography demonstrated pansinusitis. Lumbar puncture produced purulent cerebrospinal fluid with 11,500 cells/microliters, predominantly granulocytes, protein 205 mg/dl, glucose 19 mg/dl, indicating bacterial meningitis. The suspected diagnosis of posttonsillitis septicaemia (Lemierre's syndrome) was confirmed by repeated demonstration of fusiform gram-negative bacteria in anaerobic blood cultures, identified as Fusobacterium necrophorum. Anaerobic CSF culture grew Prevotella bivia of the Bacteroidaceae family.

Treatment and course: Both the consumptive coagulopathy and the renal failure were successfully treated and the patient's condition stabilized. The sinuses were surgically drained under high doses of piperacillin/sulbactam and chloramphenicol. Despite the sensitivity of the cultured bacteria to the administered antibiotics the septic temperature continued, but disappeared within 4 days of metronidazole having been added. After 5 weeks of antibiotic treatment, three of them in an intensive care unit, the patient was discharged in good general condition.

Conclusion: This case illustrates that severe septicaemia caused by rare bacteria may follow an attack of infectious mononucleosis which had taken an uncomplicated course.

Publication types

  • Case Reports
  • English Abstract

MeSH terms

  • Acute Kidney Injury / etiology*
  • Adolescent
  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia / drug therapy
  • Bacteremia / etiology*
  • Chloramphenicol / therapeutic use
  • Disseminated Intravascular Coagulation / etiology*
  • Drainage
  • Follow-Up Studies
  • Fusobacterium Infections / drug therapy
  • Fusobacterium Infections / etiology*
  • Fusobacterium necrophorum*
  • Humans
  • Infectious Mononucleosis / complications*
  • Male
  • Meningitis / drug therapy
  • Meningitis / etiology*
  • Metronidazole / administration & dosage
  • Penicillins / therapeutic use
  • Piperacillin / therapeutic use
  • Sinusitis / complications*
  • Sinusitis / surgery
  • Sulbactam / therapeutic use
  • Syndrome
  • Time Factors
  • Tonsillitis / complications*


  • Anti-Bacterial Agents
  • Penicillins
  • Metronidazole
  • Chloramphenicol
  • Sulbactam
  • Piperacillin