Introduction Lemierre’s syndrome, characterized by internal jugular vein thrombosis and secondary septic emboli following an oropharyngeal infection, is mainly caused by Fusobacterium necrophorum . We report a case of Lemierre’s syndrome caused by Porphyromonas asaccharolytica , resulting in pulmonary septic embolism, acute respiratory failure, meningitis, epiduritis, and monoplegia—a complication not previously reported. Case Report A 50‐year‐old woman initially presented with tonsillitis and subsequently developed severe sepsis. Clinical examination revealed meningeal stiffness, acute renal failure, elevated inflammatory markers, and severe thrombocytopenia. Cerebrospinal fluid analysis was consistent with meningitis, although cultures remained negative. Following admission, the patient developed acute respiratory failure, requiring transfer to intensive care unit for noninvasive ventilatory support. Computed tomography revealed tonsillar edema, thrombosis of the left internal jugular vein, and bilateral pulmonary consolidations. Empirical treatment was initiated with broad‐spectrum antibiotics (ceftriaxone, metronidazole, piperacillin–tazobactam), platelet transfusions, and intravenous heparin. Blood cultures identified P. asaccharolytica , leading to de‐escalation of antibiotic therapy to amoxicillin. Two days later, the patient developed left upper limb palsy. Magnetic resonance imaging showed cervical epiduritis extending from C3 to C7. Corticosteroid therapy was initiated on Day three. The patient was transferred to the medical ward on Day fifteen and discharged from hospital on Day 30. Treatment comprised 4 weeks of corticosteroids therapy and 6 weeks of antibiotic therapy. At follow‐up, partial neurological recovery was observed; however, residual left upper limb paresis persisted. Anticoagulation therapy was maintained for 3 months. Electroneuromyography revealed axonal injury involving the C6‐C7‐C8‐T1 nerve root distribution. Conclusion P. asaccharolytica is a rare etiological agent of Lemierre’s syndrome. Neurological complications are uncommon but may include meningitis, cerebral abscess, or cranial nerve palsies, the latter being more commonly associated with F. necrophorum . We report the case of a 50‐year‐old woman with Lemierre’s syndrome caused by P. asaccharolytica , who presented with monoplegia, epiduritis, and meningitis.
Krin et al. (Thu,) studied this question.