Lemierre’s syndrome: a role for thrombectomy, a case report

Abstract

: A 55-year-old woman with no significant past medical history presented with concerns of a retropharyngeal abscess (RPA) associated with bilateral internal jugular vein (IJV) thromboses. Computed tomography (CT) demonstrated the RPA, in addition to bilateral IJV thrombosis and ground-glass opacities in the lungs suggestive of Lemierre syndrome. This rare syndrome begins as an oropharyngeal infection and frequently involves inflammation within the vein wall, infected thrombus, surrounding soft tissue inflammation, persistent bacteremia, and septic emboli. Diagnosis is purely clinical; prompt and timely identification and treatment of Lemierre syndrome decreases mortality by a factor of 4. Standard treatment is tailored antibiotic administration, though other therapies such as anticoagulation and interventional procedures such as thrombectomy remain controversial and debated. The available literature does not elucidate a role for thrombectomy. We present a patient who did not improve with antibiotics and systemic anticoagulation and it was not until IJV thrombectomy that the patient demonstrated clinical improvement. From our literature review, there are no current case reports published where thrombectomy was used in the treatment of Lemierre. However, there are a few published articles that suggest some benefit to patients with treatment resistant Lemierre, given extrapolated data from thrombectomy used in the treatment of septic thrombophlebitis of the extremities. With the advancement of medical technology, new interventional methodologies should be adopted to treat this disease.