European Journal of Case Reports in Internal Medicine


The European Journal of Case Reports in Internal Medicine is an official journal of the European Federation of Internal Medicine (EFIM). The journal wants to promote the practice of internal medicine in Europe. Its aim is to provide a forum to internal medicine doctors.
EJCRIM welcomes papers describing unusual or complex cases and case series that an internist may encounter in everyday practice. Case series are also welcomed as long as they demonstrate the appropiateness of a therapeutical approach or unusual manifestation of a disease.
The journal would also consider brief reasoned reports of issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to scientific meetings of European societies of Internal Medicine.

EJCRIM is peer-reviewed with single-blind review and freely accessible to all.

Patrícia Afonso Mendes, Emilia Trigo, Rui Pina, Paulo Martins, Jorge Pimentel
Rakshita Chandrashekar, Monoj Kumar Konda, Vishal Gupta, Jagadeesh K Kalavakunta
Katya Muscat, Ruth Galea, Malcolm Vella
Faye Pais, Mohamed Fayed, Timothy Evans
Mohamad Jaffer Abdalkhalig Mustafa, Mohamed Bakri Mohamed, Amjad Hayat
Giagkos Michael Lavranos, Demetra Kouma, Antonis Deveros, Georgia Pigiotou, Georgios Samanis, Chrysostomos Zintilis
Paschalis Sidiras, Frédéric Vandergheynst, Laurine Verset, Hazim Kadhim, Muhammad Shahnawaz Soyfoo
Gizem Zorlu, Seyit Uyar, Hakan Ozer, Murat Esin, Selin Kir, Abdullah Tokuc, Süleyman Dolu, Feyzi Bostan, Ayhan Hilmi Cekin

Complicated Lemierre Syndrome Caused by Streptococcus gordonii and Possible Rickettsial Co-Infection in a Patient with Thrombophilia Predisposition

Antreas Ioannou, Dimitra Dimitriou, Panagiotis Dimitriou, Aram Katsios, Georgios Petrikkos
Published: 17/03/2017


Aims: Lemierre syndrome is a life-threating condition characterized by recent oropharyngeal infection, internal jugular vein thrombosis, and anaerobic septicemia. It is usually caused by Fusobacterium necrophorum.
Methods: A young Romanian male presented with fever and rigors, mild tachypnea, hypoxia, sore throat, decayed teeth, and tenderness of the left carotid triangle. Laboratory examination indicated severe sepsis with disseminated intravascular coagulation, acute renal failure, and acute respiratory distress syndrome while the Doppler ultrasonography of the carotids revealed left internal jugular venous thrombosis. The patient was administered piperacillin/tazobactam and vancomycin intravenously, doxycycline orally, and anti-coagulation by enoxaparin based on the diagnosis of Lemierre syndrome. Meanwhile, he was complicated by bilateral diffuse pulmonary cavities and encapsulated pleural effusions and so transcutaneous drainage was performed. The patient was discharged after a month and continued his treatment with oral phenoxypenicillin and doxycycline until full radiographic improvement. He was switched to oral anti-coagulation by vitamin-K antagonists and was referred to a hematologist, a vascular-surgeon, and a dentist...