Lemierre's Syndrome: A Case Report with Fatal CNS Complications

Jocelyn Zee

doi:10.23937/2474-3682/1510048

Abstract

Lemierre's syndrome is a rare disorder of young adults, usually caused by the anaerobic bacterium, Fusobacterium necrophorum and occasionally by other Fusobacterium species (F. nucleatum, F. mortiferum and F. varium etc). The condition is characterized by an oropharyngeal infection leading to inflammation of the internal jugular vein (IJ) and that can lead to septic thrombophlebitis with positive blood cultures, clinical or radiographic evidence of internal jugular vein thrombosis, and at least one metastatic focus. The incidence of Lemierre's syndrome is not known with some reporting one in a million. In the pre-antibiotic era, Lemierre's syndrome followed a fulminant, often fatal course. During the 1960s and 1970s, the syndrome was rarely reported when penicillin was commonly prescribed to treat oropharyngeal infections. However, the appearance of antibiotic-resistant organisms are leading to a rise of the condition.

Highlights

An attempt to perform embolectomy was considered but felt that it would produce further septic emboli and probably worsen her overall clinical status; in addition, because of the size of the vein there were concerns with the ability to keep it patent
The condition is characterized by an oropharyngeal infection leading to inflammation of the internal jugular vein (IJ) and that can lead to septic thrombophlebitis with positive blood cultures, clinical or radiographic evidence of internal jugular vein thrombosis, and at least one metastatic focus
We reviewed the literature and present a case report of a 30-year-old patient that presented with a peritonsillar abscess and rapidly progressed to develop proptosis, lateral rectus palsy and devastating ischemic stroke and subsequent brain death

Summary

Introduction

An attempt to perform embolectomy was considered but felt that it would produce further septic emboli and probably worsen her overall clinical status; in addition, because of the size of the vein there were concerns with the ability to keep it patent. We reviewed the literature and present a case report of a 30-year-old patient that presented with a peritonsillar abscess and rapidly progressed to develop proptosis, lateral rectus palsy and devastating ischemic stroke and subsequent brain death. Because the left internal jugular vein did not contribute significantly to her cerebral venous outflow, and there was no evidence that thrombosis of this vein or of the left sigmoid sinus were associated with her worsening mental status, it was decided not to proceed with the procedure.

Results

Conclusion