LEMIERRE'S SYNDROME: THE FORGOTTEN DISEASE

Abstract

TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: Septic thrombophlebitis of the internal jugular vein (IJV) is a rare complication of anaerobic oropharyngeal infection. We present a case of Lemierre’s syndrome which was managed without systemic anticoagulation therapy. CASE PRESENTATION: A 63 year old female presented to the hospital with left jaw pain for one week. The admission labs were pertinent for leukocytosis, lactic acidosis, acute kidney injury and thrombocytopenia. Oral physical exam was significant for submandibular tenderness, ulcerative pharyngitis and tonsillitis. She was initiated on broad spectrum antibiotics. A venous ultrasound of the left upper extremity revealed an acute deep vein thrombosis in her left IJV and an acute superficial venous thrombosis in the right cephalic vein. The blood culture later grew an anaerobic gram negative bacteremia, identified to be part of the Fusobacterium species. The patient was managed on IV Unasyn for two weeks; she improved and her abnormal labs resolved. She was discharged with Amoxicillin for two weeks. DISCUSSION: The typical clinical picture of Lemierre’s syndrome is an acute oropharyngeal infection, anaerobic gram negative bacterial infection and an acute thrombosis of the internal jugular vein. Antibiotics are currently the primary treatment of this condition. Despite thrombosis of IJV, treatment with anticoagulation therapy remains unclear. CONCLUSIONS: We wish to highlight the importance of recognising Lemierre’s syndrome due to its increasing resurgence and high mortality rate (25%) if not treated adequately with antibiotics. This case also emphasises septic thrombophlebitis in the hospital setting and the need for further controlled studies to establish the role of anticoagulation therapy. DISCLOSURE: Nothing to declare. KEYWORD: lemierre's syndrome