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  • Pathological fracture of the femoral neck following septic coxitis and chronic osteomyelitis: a potential complication of Lemierre’s syndrome

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Rare disease
CASE REPORT
Pathological fracture of the femoral neck following septic coxitis and chronic osteomyelitis: a potential complication of Lemierre’s syndrome
  1. Dominik Maximilian Vogt1,
  2. Ludger Tüshaus2,
  3. Martin Kaiser2,
  4. Martin Russlies1
  1. 1Klinik für Orthopädie und Unfallchirurgie, Universitatsklinikum Schleswig Holstein - Campus Lübeck, Lübeck, Germany
  2. 2Klinik für Kinderchirurgie, Universitatsklinikum Schleswig Holstein - Campus Lübeck, Lübeck, Germany
  1. Correspondence to Dr Dominik Maximilian Vogt, dominik.vogt{at}uksh.de

Summary

We portray the case of a 16-year-old girl who was initially admitted to the paediatric emergency department with non-specific symptoms of a severe cold and was first treated symptomatically on an ambulatory basis. Within 6 days she developed the full clinical picture of Lemierre’s syndrome with the extraordinary manifestation of involvement of her right hip. Despite an interdisciplinary coordinated treatment as well as surgical therapy, a full-blown sepsis evolved within a short time period and resulted in almost 2 months of intensive care. While the primary focus could be successfully controlled, a progressive avascular necrosis of the right proximal femur developed on the basis of a chronic osteomyelitis. This finally led to a pathological fracture of the femoral neck. After excluding the possibility of an enduring bacterial infection, the fracture was treated with a total hip replacement.

  • Orthopaedics
  • Paediatrics
  • Bone and joint infections
  • Ear, nose and throat/otolaryngology

https://doi.org/10.1136/bcr-2016-218474

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    Footnotes

    • Contributors MR, LT and MK were responsible for the patient’s treatment and also for most of the acquisition, analysis, interpretation and reporting of the patient’s data in terms of imaging techniques, laboratory tests and clinical findings. MR was mainly responsible for the treatment of the patient’s hip, whereas MK and LT managed the general treatment of the Lemierre’s syndrome and therefore performed a systematic literature research. DMV was — supervised by MR — mainly responsible for the conception and writing of this article based on the data provided by MR, LT and MK and another systematic literature research. All authors were directly involved in the writing process by revising, discussing and modifying the article’s text and content.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.