Lemierre Syndrome Presenting with Septic Pulmonary Embolism and Diffuse Vesiculopustular Skin Rashes: A Case Report

Abstract

Lemierre syndrome is usually an anaerobic infection of the oropharyngeal space, followed by septic thrombophlebitis of the internal jugular vein and metastatic infections by septic embolization. The most common site of metastatic infection is the lungs, as well as other sites, including the joints, soft tissue and central nervous system. Skin involvement is a less common presentation as a consequence of continuous bacteremia, according to the previous literature. We describe a young man with the initial presentation of sore throat, and who subsequently developed fever, neck pain and generalized skin vesiculopustular rashes. Neck computed tomography (CT) scans demonstrated right parapharyngeal abscess and thrombosis of the external jugular vein. Hospitalization was complicated with septic shock and acute hypoxic respiratory failure. Fusobacterium necrophorum was isolated from the blood culture. Successful treatment was achieved by intravenous antibiotics with surgical drainage for the deep neck infection and the ligation/excision of external jugular vein thrombosis. Although the main treatment for Lemierre syndrome is intravenous antibiotics with good anti-anaerobic activity, surgical debridement, as well as ligation and excision of the thrombosed jugular vein, may be necessary for uncontrolled infection and repeated septic embolization.