Lemierre syndrome caused by acute isolated sphenoid sinusitis and its intracranial complications

Abstract

Classically, Lemierre syndrome is a rare clinical entity in which acute oropharyngeal infection causes septic internal jugular vein thrombosis and leads to septic lesions to distant organs, such as the lung. Lemierre syndrome also presents with odontogenic infections, mastoiditis, parotitis, and sinusitis. We report the first case of Lemierre syndrome following acute isolated sphenoid sinusitis that was complicated with cavernous sinus thrombophlebitis and bilateral infectious aneurysms of the intracavernous internal carotid artery. Treatment with endoscopic sphenoidotomy, culture-directed antibiotics, heparinization, and endovascular GDC coiling were performed and the patient recovered without major neurologic morbidity. Immediate and intensive treatment with careful evaluation to localize the primary infectious focus of the head and neck, including the paranasal sinus, improves the prognosis of patients with rhinogenic Lemierre syndrome.