Leptomeningeal metastasis from lung adenocarcinoma associated with Lemierre syndrome in a middle-aged man: a case report and review of the literature.

backgroundLemierre syndrome (LS), predominantly triggered by oropharyngeal infection with Fusobacterium necrophorum, is a rare but life-threatening condition. The co-occurrence of LS with leptomeningeal metastases (LM) from lung adenocarcinoma (LADC) is exceptionally scarce, with only a handful of cases documented in the literature. CASE PRESENTATION: A 42-year-old male presented with neck pain and infection, which progressed to cervical venous thrombosis, cervical lymphadenopathy, and multiple pulmonary nodules, features consistent with a diagnosis of LS. The patient received targeted treatment for LS, including anticoagulation, broad-spectrum antibiotics with anaerobic coverage (piperacillin-tazobactam 4.5 g every 8 h for 2 weeks), and anti-inflammatory agents. Shortly after the successful LS treatment, the patient developed chest pain; computed tomography (CT) imaging revealed residual lung nodules, and further pathological examination confirmed LADC. He subsequently started LADC-specific therapy combining targeted agents and chemotherapy. Later, the patient reported persistent headache; enhanced brain CT confirmed LM from LADC. His treatment regimen was adjusted to include an increased dose of osimertinib.

conclusionsThis case underscores the importance of heightened clinicians’ awareness of the complex interplay between LADC leptomeningeal metastases and LS. Early recognition and multidisciplinary intervention in such multifaceted cases are crucial for optimizing patient outcomes. CLINICAL TRIAL NUMBER: Not applicable.