Garbati et al. Journal of Medical Case Reports 2012, 6:97 http://www.jmedicalcasereports.com/content/6/1/97 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Lemierre’s syndrome due to Klebsiella pneumoniae in a 63-year-old man with diabetes: a case report Musa A Garbati*, Azeem M Ahsan and Ahmed M Hakawi Abstract Introduction: Lemierre’s syndrome was originally documented to be caused by Fusobacterium necrophorum. It is a very rare condition with a prevalence of one to 14.4 instances per million. Its presentation is varied, not only in composition but also in the infecting organism. Treatment with anticoagulants has been controversial and applied only on a case-by-case basis. Case presentation: A 63-year-old Saudi man who had had uncontrolled diabetes mellitus for 47 years presented to our facility with a five-day history of swelling on the right side of his neck and fever. The swelling progressively increased in size and was associated with pain, dysphagia, odynophagia, change of voice (’hot potato voice’), and reduced appetite. Abscess content culture and sensitivity testing revealed Klebsiella pneumoniae. However, blood culture results were repeatedly negative. The abscess was incised and drained without any complication. Our patient was treated with clindamycin and cefuroxime. Warfarin was also administered concurrently for six weeks, for an isolated internal jugular vein thrombosis (IJV), with complete resolution of the thrombus. Normoglycemia was achieved and our patient was discharged after complete wound healing and the return of his biochemical parameters to normal. Conclusions: Only two cases of Lemierre’s syndrome in patients with diabetes due to K. pneumoniae have been reported previously. A review of the literature suggested that an association exists between deep neck infections due to K. pneumoniae and diabetes mellitus. The reasons for this association are still not clear. This poses a question as to whether diabetes mellitus specifically predisposes these patients to infection with this organism. It is suggested that clinicians should consider infectious agents other than F. necrophorum in the causation of Lemierre’s syndrome, especially in patients with diabetes. Introduction Post-anginal sepsis, otherwise known as Lemierre’s syn- drome (LS) or necrobacillosis, was first reported by Courmont and Cade in 1900 [1]. The condition was bet- ter described by Andre Lemierre in 1936 [2] from a report of 20 cases. The hallmark of the syndrome, as was originally described by Lemierre, is a tetrad of acute oropharyngeal infection, septicemia, thrombophlebitis of the ipsilateral internal jugular vein (IJV), and secondary metastatic abscesses, most commonly to the lungs and joints. The syndrome has mainly been described in young, immunocompetent individuals, with a prevalence * Correspondence: musagarbati@yahoo.com Division of Infectious Diseases, Department of Medicine, King Fahad Medical City, 11525, Riyadh, Saudi Arabia of one to 14.4 instances per million. This condition therefore requires a high index of suspicion for diagno- sis [3]. The initiating infection is usually due to a Gram- negative anaerobe, F. necrophorum (previously known as Bacillus fundiliformis), but other organisms have also been implicated. Occasionally, no organisms were grown from clinical specimens [4]. LS was reported to be usually fatal prior to the discov- ery of antibiotics, with up to 90% mortality. The intro- duction of penicillin in the 1940s for oropharyngeal infections led to a significant drop in the incidence of the disease and its associated mortality (to as low as 5%) [5]. This has led to the disease becoming forgotten [6] and also to the appearance of incomplete forms of the syndrome. © 2012 Garbati et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.