Lemierre Syndrome: Two Cases Requiring Surgical Intervention

Abstract

1 s i 1 r ( 2 m b ( t a b n 5 Lemierre syndrome, also known as postanginal sepsis or human necrobacillosis, is a severe complication of an acute oropharyngeal infection that results in septic thrombophlebitis of the ipsilateral internal jugular vein (IJV) followed by sepsis. The infections are frequently complicated by metastatic infections spread from an infection originating in the mouth or pharynx. The most common causative organism is Fusobacterium necrophorum, a commensal organism of the oral cavity. After the widespread use of antibiotic therapy, largely with penicillin in the 1960s and 1970s for oropharyngeal infections, Lemierre syndrome was referred to as the “forgotten disease.” Today, with the decreased use of antibiotics for oropharyngeal infections and the increased numbers of antibiotic-resistant organisms, the disease has reemerged. We describe 2 cases of Lemierre syndrome that required surgical intervention. Courmant Cade, in 1900, and then Schottmuller, in 1918, made a correlation between oropharyngeal infection and the occurrence of sepsis. Andre Leierre, a French microbiologist, was the first to fully escribe the syndrome in 1936. The syndrome is haracterized by anaerobic septicemia, internal juguar vein (IJV) thrombosis, and septic emboli that arise econdary to infections in the head and neck. Leierre described 20 cases; of those 20, 18 patients ied. The mortality was 90% in the preantibiotic era. Classic Lemierre syndrome, as coined by Sinave et al, usually involves 4 symptoms for an appropriate