The interesting case of Lemierre syndrome requiring pleural decortication described by A. T. Lanfear and colleagues is of particular clinical interest, as it emphasizes the high intensity of surgical treatment required in Lemierre syndrome.1 This aspect has been poorly explored, and awareness of Lemierre syndrome as a disease often requiring surgical treatment is scant. As the incidence of this condition may be increasing in the absence of a consensus on its management,2 there is some urgency to make the most of available evidence to guide physicians treating patients with Lemierre syndrome and to define the roles of the multidisciplinary teams that often end up being involved.
In the largest study of Lemierre syndrome to date, reporting global cases from 2000 to 2017,3 109 (17% of the total study population of patients with Lemierre syndrome) required drainage of a pleural empyema. Pleural decortication was necessary in 14 (2%) patients. Of these 14 cases, 5 decortications were performed to address a complication that arose after diagnosis was made and treatment was initiated with antibiotics and, if deemed appropriate by the treating physicians, anticoagulant agents.4
This suggests that there may be room for improvement in the early management of patients with pulmonary involvement in Lemierre syndrome, represent the majority of those presenting with this condition (over 70% in the above-mentioned study). Accordingly, in addition to Lanfear and colleagues’ recommendation to add chest imaging and pleural fluid sampling to the diagnostic workup,1 we would argue for early involvement of chest surgeons in the management of patients with Lemierre syndrome, with a low threshold for consults from the moment of diagnosis. As is the case for acute pulmonary embolism with pulmonary embolism response teams,5 the management of an acute condition like Lemierre syndrome should be multidisciplinary and involve medical and surgical specialists.
—Luca Valerio, MD
Center for Thrombosis and Hemostasis
University Medical Center of the Johannes Gutenberg University
Mainz, Germany
luca.valerio@uni-mainz.de
—Stefano Barco, MD, PhD
Clinic of Angiology, University Hospital Zurich
Zurich, Switzerland
References
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