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28 February 2019 : Case report  Japan

An Unusual Presentation of Nasopharyngeal Carcinoma as Lemierre Syndrome

Challenging differential diagnosis

Tsuyoshi Ito1ABCDEF*, Hisakazu Majima1ABCD, Taijiro Ozawa2ABCD, Matsuyoshi Maeda3ABCD, Shotaro Iwamoto4ABCD, Masahiro Hirayama4ABCD, Eiichi Azuma5ABCDEF

DOI: 10.12659/AJCR.913755

Am J Case Rep 2019; 20:263-267

Abstract

BACKGROUND: Clinical presentation of nasopharyngeal carcinoma (NPC) is correlated with the extent of primary and nodal disease. Hence, depending on the anatomical structures affected, the clinical presentation varies accordingly, ranging from non-specific symptoms of epistaxis, unilateral nasal obstruction, and auditory complaints, to cranial nerve palsies. Nodal metastasis in the neck is a frequent clinical finding in nasopharyngeal carcinoma.

CASE REPORT: A female was admitted to the hospital because of fever and trismus with painful swelling in the right neck. Computed tomography (CT) revealed a mass in the nasopharynx with heterogeneous enhancement and multiple swollen lymph nodes in the corresponding neck. Initial biopsies of nasopharyngeal mass and lymph node of the neck revealed nonspecific lymphoid hyperplasia; we administered antibiotics with the provisional diagnosis of bacterial infection, including Lemierre syndrome that is typically defined by the constellation of septic internal jugular vein thrombophlebitis, pulmonary and other septic emboli, and sterile site bacterial infection. However, the patient was refractory to antibiotics over a month of treatments. The third biopsy of the throat lesion revealed NPC and bacterial cultures using the biopsy specimen were negative. She received intensity-modulated radiation therapy and chemotherapy for NPC stage II (TNM staging: T2N1M0). She never developed Lemierre syndrome-like symptoms after chemoradiotherapy.

CONCLUSIONS: We report a unique case of NPC presenting with Lemierre syndrome-like symptoms, including prior sore throat, trismus, painful swollen neck, and high fever. Since these symptoms have not been reported in NPC, we included NPC as a differential diagnosis.

Keywords: Lemierre Syndrome, Nasopharyngeal Neoplasms, Trismus, Adolescent, nasopharyngeal carcinoma

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923