Lemierre’s Syndrome – Case Report of a 20-Year-Old Male with Post-Anginal Sepsis

Abstract

<b>Introduction:</b> Lemierre’s syndrome, first described by André Lemierre in 1936, is a rare but life-threatening condition. It is characterized by a triad of symptoms: pharyngeal infection, internal jugular vein thrombosis, and sepsis with distant abscesses, usually in the lungs. The primary pathogen is the anaerobic Gram-negative bacterium <i>Fusobacterium necrophorum</i> (<i>F. necrophorum</i>). In recent years, there has been an increase in the incidence of Lemierre’s syndrome.<b>Case report:</b> A 20-year-old male was admitted to the Emergency Department (ED) with jaundice, dyspnea, sore throat, fever up to 39C, neck pain, and left lower limb weakness. Examination revealed enlarged palatine tonsils with purulent exudates and a right-sided peritonsillar abscess. Laboratory tests showed elevated inflammatory markers, thrombocytopenia, and leukocytosis. Computed topography (CT) confirmed internal jugular vein thrombosis, abscesses in the right sternocleidomastoid muscle, and bilateral pleural effusions. The patient received oxygen therapy, antibiotics, anticoagulation, and pleural drainage. After 26 days of hospitalization, he was discharged with a recommendation to continue antibiotic therapy and low-molecular-weight heparin, as well as planned removal of the palatine tonsils (tonsillectomy).<b>Discussion:</b> Lemierre’s syndrome is a severe complication of upper respiratory tract infections, mainly affecting young individuals. Symptoms include pharyngeal infection, sepsis, and internal jugular vein thrombosis. Early diagnosis and appropriate treatment, including prolonged antibiotics and sometimes anticoagulation, are crucial. The rise in incidence may be linked to the irrational use of antibiotics. Educating clinicians is vital to improve outcomes and reduce complications.<b>Conclusions:</b> Initial symptoms of Lemierre’s syndrome are nonspecific, complicating early diagnosis. Neck imaging and/or positive blood cultures are key for diagnosis. The incidence is 1–2.5 cases per million annually, making it rare but potentially fatal. Mortality before antibiotics was around 90%; currently, it is 5–18%, but higher without proper diagnosis. Early imaging significantly improves prognosis.