POST-TONSILLITIS SEPTICEMIA WITH MENINGIT IS AND INTRAVASCULAR CONSUMPTIVE COAGULOPATHY AS COMPLICATION OF INFECTIOUS-MONONUCLEOSIS WITH PANSINUSITIS

History and clinical findings: 24 days after the onset of infectious m ononucleosis, clinically and serologically confirmed, an otherwise hea lthy 18-year-old schoolboy developed a fulminant septicaemia with acut e meningitis and loss of consciousness, consumptive coagulopathy and a cute renal failure. Investigations: Computed tomography demonstrated p ansinusitis. Lumbar puncture produced purulent cerebrospinal fluid wit h 11500 cells/mu l, predominantly granulocytes, protein 205 mg/dl, glu cose 19 mg/dl, indicating bacterial meningitis. The suspected diagnosi s of posttonsillitis septicaemia (Lemierre's syndrome) was confirmed b y repeated demonstration of fusiform gram-negative bacteria in anaerob ic blood cultures, identified as Fusobacterium necrophorum. Anaerobic CSF culture grew Prevotella bivia of the Bacteroidaceae family. Treatm ent and course: Both the consumptive coagulopathy and the renal failur e were successfully treated and the patient's condition stabilized. Th e sinuses were surgically drained under high doses of piperacillin/sul bactam and chloramphenicol. Despite the sensitivity of the cultured ba cteria to the administered antibiotics the septic temperature continue d, but disappeared within 4 days of metronidazole having been added. A fter 5 weeks of antibiotic treatment, three of them in an intensive ca re unit, the patient was discharged in good general condition. Conclus ion: This case illustrates that severe septicaemia caused by rare bact eria may follow an attack of infectious mononucleosis which had taken an uncomplicated course.