Lemierre's Syndrome in a Patient with Severe Lupus Nephritis

B P Paudyal

doi:10.31729/jnma.37

Abstract

Lemierre's syndrome is a rare septic thrombophlebitis of the internal jugular vein with frequent metastatic complications following an acute oropharyngeal infection. Immunocompromised patients are at higher risk of developing this syndrome owing to the decreased host response and increased risk of oropharyngeal sepsis. We herein report a 24-year-old woman with severe lupus nephritis on immunosuppressive therapy, who developed Lemierre's syndrome following a pharyngeal infection despite an adequate and timely antibiotic therapy. We hereby draw an attention to the importance of accurate and timely diagnosis and appropriate management of Lemierre's syndrome in immunocompromised patients so as to achieve a successful prognosis for this deadly infection.

Highlights

Lemierre’s syndrome is a septic thrombophlebitis of the internal jugular vein that develops as an important complication of an oropharyngeal infection.[1]
We report a case of this deadly infection in a patient with severe systemic lupus erythematosus (SLE) with nephritis, a case on which there are very few reports in the medical literature
A doppler ultrasound of the neck revealed a noncompressible and grossly-dilated left internal jugular vein (IJV) with an echogenic wall and a thick lumen containing a heterogenous thrombus extending to a length of 5 cm (Figure 2)

Summary

INTRODUCTION

Lemierre’s syndrome is a septic thrombophlebitis of the internal jugular vein that develops as an important complication of an oropharyngeal infection.[1]. She presented to the Emergency Department of our hospital with irrelevant talks, unusual behaviour, and a staring look that promptly improved when the prednisolone dose was lowered to 20 mg per day. Her investigations at the time of admission were normal hemogram, Creatinine. The patient was treated with intravenous cyclophosphamide pulse of 800 mg for her lupus nephritis. Over the days, she showed a steady improvement and was discharged from the hospital. The further plan is to replace cyclophosphamide with azathioprine for the maintenance therapy of her lupus nephritis

DISCUSSION

Findings

Metastatic Infection