Lemierre syndrome - treat with antibiotics, anticoagulants or both?

Abstract

Lemierre syndrome is septic thrombophlebitis in the internal jugular vein due to oropharyngeal bacterial infection. The most frequent culprit is the gram negative anaerobe Fusobacterium necrophorum. The syndrome has its name from André-Alfred Lemierre (1875-1956), professor in bacteriology in Paris, who in 1936 published a case series of 20 patients with fatal outcome in 18 (90%).[1] At the time when Lemierre described the disease it was much more common than presently. Sibai and Sarasin estimated the incidence in 2004 to 0.8 per million,[2] but it is higher in the subset of children and young adults. Karkos et al concluded in 2004 after treating a case and performing a brief literature review that there is no evidence for a beneficial effect of anticoagulant therapy.[3] On the contrary, Carlson et al favored initial heparinization, followed by warfarin for 6 months,[4] based on positive experience with heparin in septic pelvic thrombophlebitis. It has understandably been difficult to establish an evidence-based guideline for management of patients with this rare syndrome.