CHEST Guidelines-A-19-Year-Old-College-Student-With-Headache,-Photo (1)

A-19-Year-Old-College-Student-With-Headache,-Photo (1)

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The document details a case study of a 19-year-old college student who presented with symptoms including headache, photophobia, fever, neck stiffness, and respiratory distress. The patient, who lived in a dormitory and had no history of travel or substance abuse, was minimally responsive and suffering from a suspected infection after being transferred to a hospital. Diagnostic procedures revealed several abnormalities, including elevated white blood cell count, renal issues, and a positive blood culture for Fusobacterium necrophorum, a gram-negative anaerobic bacterium often associated with serious infections.<br /><br />Further imaging studies identified multiple pulmonary nodules, a hepatic abscess, and enteritis, leading to a diagnosis of Fusobacterium necrophorum sepsis and hemophagocytic lymphohistiocytosis (HLH)—a life-threatening syndrome of excessive immune activation. HLH was suggested by elevated ferritin levels and confirmed via bone marrow biopsy showing hemophagocytosis.<br /><br />Fusobacterium necrophorum is known for causing Lemierre syndrome, characterized by internal jugular vein thrombosis and potentially leading to septic shock. The treatment involved broad-spectrum antibiotics like meropenem and linezolid, and high-dose corticosteroids. After aggressive treatment, including percutaneous drainage of the hepatic abscess and intubation, the patient's symptoms and lab results improved. <br /><br />Key clinical insights include recognizing Fusobacterium necrophorum infections as they might lead to bacteremia, septic emboli, and abscesses in immunocompetent individuals. HLH should be considered in non-resolving sepsis cases. The educational takeaway emphasizes would-be screening for secondary HLH, especially with persistent fever or unexplained cytopenias, and appropriate treatment involving antibiotics and potential corticosteroids use. The case underscores the importance of considering a wide range of potential diagnoses in complex cases involving severe systemic infections.

Keywords

Fusobacterium necrophorum

Lemierre syndrome

hemophagocytic lymphohistiocytosis

sepsis

bacteremia

pulmonary nodules

hepatic abscess

broad-spectrum antibiotics

immune activation

septic shock