(651) Not Lemierre: Marijuana as a Possible Source of Fusobacterium Septic Emboli Without Thrombosis

Introduction: Fusobacterium necrophorum (FN) is a gram-negative anaerobic bacteria associated with Lemierre’s Syndrome, septic thrombophlebitis of the internal jugular vein commonly from oral infections. Once translocated, FN can cause embolic abscesses. Risk factors include diabetes, immunocompromised state, or recent instrumentation. We report a case of a healthy male, without oral infection, IV drug use, or recent surgery, who presented with an FN bacteremia and Candida fungemia that caused cavitary pulmonary lesions and septic arthritis, possibly from marijuana resin.

Description: A 31-year-old male presented to an outside hospital with two weeks of fever, gastroenteritis, myalgias, and cough. He was found to have anemia, acute kidney injury, and severe thrombocytopenia, and was transferred to our quaternary center with concern for thrombotic thrombocytopenic purpura or hemolytic uremic syndrome.

The patient reported daily marijuana use via “dab” and vaping of THC oil, but no other drug use. Further history revealed a shoulder injury two weeks prior while lifting weights, but no joint injections. The patient developed atrial fibrillation, hypotension, hypoxia and was upgraded to the ICU.

CT revealed pulmonary cavitary lesions concerning for septic emboli and gas in the left shoulder, suspicious for a necrotizing infection. Blood cultures grew FN and Candida albicans. Neck imaging was negative for thrombosis and TEE showed no vegetations.

The fungemia and bacteremia were treated, and the shoulder underwent serial debridements. His course was complicated by septic shock, ARDS, and acute renal failure requiring CVVH. The patient required a prolonged ICU stay, but recovered and was discharged.

Discussion: This case highlights the heterogenicity of FN infections and raises concern for marijuana resin as a source. Our patient’s disease process was not consistent with Lemierre’s Disease or endocarditis, as he did not have thrombosis, oral infection or valvular vegetations. The only risk factor was frequent marijuana resin use, which reports have shown can contain fusobacterium and candida. The Department of Health was contacted to test the resin but was unsuccessful. As marijuana is legalized across America, it is important to recognize the risks of marijuana exposure when evaluating patients.