Case Report: Abdominal variant of Lemierre’s syndrome

Abstract

Lemierre's syndrome is a rare condition characterized by Fusobacterium bacteremia from an oropharyngeal source with septic emboli causing internal jugular vein (IVJ) thrombophlebitis in an otherwise young and healthy host. Rare variants of this rare disease have been described impacting the gastrointestinal, pulmonary, neurologic, musculoskeletal, soft tissue, and genitourinary systems. We discuss a case of an abdominal variant of Lemierre's syndrome. An otherwise young and healthy male presented with two pyogenic hepatic abscesses, Fusobacterium necrophorum bacteremia, and local hepatic venous thrombosis. The hepatic abscesses were percutaneously drained, he received broad-spectrum antibiotics and therapeutic-level anticoagulation, and he showed marked clinical improvement over a six-day hospital course. He was discharged with four weeks of daily oral and intravenous (IV) antibiotics, six months of direct oral anticoagulation, and close follow up. Clinicians should consider thrombophlebitis in more anatomical locations than the IVJ which is found classically in Lemierre’s syndrome in the setting of Fusobacterium bacteremia.