Cavitary lung lesions, Lemierre's syndrome

Thanks Joel for a great case! This is a case of a young person with recent URI symptoms presenting with chest pain and shortness of breath found to have cavitary lung lesions and fusobacterium bacteremia thought to have had transient Lemierre's syndrome.

 From radiopaedia.org

From radiopaedia.org

Main points:

  1. Smoking marijuana (either due to inhaling spores from smoking or aleveolar damage from smoking) predisposes immunocompromised hosts to invasive pulmonary aspergillosis
  2. Septic pulmonary emboli with preceding pharyngitis should prompt consideration of Lemierre's syndrome.
  3. We discussed whether it is a good idea to anticoagulate in the setting of supperative thrombophlebitis and it remains a debated issue with no good data other than expert opinion/ case reports.

Want to learn more?

Influenza and myocardial injury

Here is a link to an interesting NEJM correlative case series coming out of a group in Canada. Approximately 300 records were pulled from hospital records of individuals who had an MI AND had PCR-proven influenza within a year of each other. It was noted that there was a strong correlation between influenza and myocardial injury within 7 days. The caveat is this doesn't tell us anything about incidence or the chance of getting one when the other happens acutely.

Cavitary lung lesions

The differential of cavitary lung lesions in an immunocompetent patient includes infectious (bacterial abscess, fungal, TB, rare viral/ parasitic) vs noninfectious etiologies (malignancy, vasculitis, sarcoid, PE w infarct, severe bronchiectasis). Here is a great article from SHM with an approach to cavitary lung lesions.