patient showed rapid signs of clinical improvement.
and AngioVac for right-sided valvular vegetations
Discussion: Our case study demonstrates a novel application of the AlphaVac system in extracting large, right-sided valvular vegetations from a patient diagnosed with infective endocarditis. Its distinct features, including targeted aspiration without the need for extracorporeal bypass, result in minimal blood loss and allow for large amounts of material to be suctioned; these features make it a promising alternative to both open heart surgery
The AlphaVac system mitigates the risks associated with open-heart surgery while offering a more efficient and reliable method for vegetation removal compared to its predecessor, AngioVac. Although FDA approved for the extraction of venous thrombi/emboli, this case demonstrates the distinct advantages of the AlphaVac system in regards to removing valvular vegetations.
ONE IN A MILLION: OCULAR MANIFESTATIONS AND PARVIMONAS MICRA INFECTION IN LEMIERRE SYNDROME Mckenzie Schwarze MD, David Janz MD; Department of Medicine, LSU Health New Orleans, New Orleans, LA.
Introduction: Lemierre syndrome is a rare and life-threatening condition characterized by septic thrombophlebitis of the internal jugular vein, primarily associated with oropharyngeal infections, and typically attributed to Fusobacterium necrophorum. With an estimated worldwide incidence of one in one million, the condition's rarity has led to diverse clinical presentations and the absence of a standardized definition. Case: A previously healthy 31-year-old female presented with a one-day history of left eye swelling and severe headache. Over the preceding week, she experienced dizziness, vomiting, cough, and dyspnea, notably without oropharyngeal symptoms. Physical examination exhibited left periorbital erythema, proptosis, conjunctival injection, limited left eye adduction, and significant pain with eye movements. The pupil was dilated and non-reactive. She was stroke activated for a gaze palsy and a computed tomography (CT) angiography of the head and neck demonstrated right internal jugular vein thrombosis. Moderate odontogenic disease was also noted on maxillofacial CT, with multiple reactive lymph nodes. Further imaging showed septic emboli in the lungs, and a wedge infarct in the spleen. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) revealed thrombi in the left superior ophthalmic vein,
cavernous sinus, right sigmoid dural venous sinus, and right proximal internal jugular vein, confirming the diagnosis of Lemierre Syndrome. The patient was managed with fluid resuscitation, broad-spectrum antibiotics, continuous heparin infusion, and admission to the intensive care unit. Neurosurgery was consulted for aspiration thrombectomy of the right internal jugular vein and sigmoid venous sinus, yielding purulent thrombi that grew Parvimonas micra. Ultimately, her condition improved and she was discharged home to complete a 6-week course of piperacillin-tazobactam, transitioned to oral anticoagulation with apixaban, and continued on topical erythromycin for orbital cellulitis. Discussion: This case underscores an unusual presentation of Lemierre syndrome and contributes to our understanding of this rare condition. It features a rarely reported infection with Parvimonas micra, an anaerobic gram-positive coccus commonly linked to periodontitis. The case provides additional insights into the ocular manifestations of Lemierre syndrome, including ophthalmic vein thrombosis and orbital cellulitis. Most importantly, it highlights the significance of considering Lemierre syndrome even when oropharyngeal symptoms are absent, emphasizing the need for vigilance in diagnosing atypical presentations.
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