Lemierre's syndrome

Lemierre's syndrome is characterized by thrombophlebitis of the internal jugular vein and a spreading secondary infection. (1,2) When it occurs, it usually does so in young, previously healthy patients following an oropharyngeal infection accompanied by a persistently high fever. The overall incidence of this syndrome appears to be increasing.

The primary pathogen in Lemierre's syndrome is Fusobacterium neerophorum, a gram-negative rod that normally inhabits the oropharynx. (1,2) Prolonged antibiotic treatment with good anaerobic coverage is vital to minimizing morbidity and mortality; the mortality rate associated with Lemierre's syndrome prior to the antibiotic era was nearly 90%. (3) Today, with early diagnosis and treatment, the mortality rate has decreased to 15%. (3)

We evaluated a 21-year-old black man who presented with exudative tonsillitis and high fever. He had no significant medical history. Computed tomography (CT) of the neck detected a thrombosis of the right anterior jugular vein that extended from the level of the hyoid to the supraclavicular area (figure, A). CT of the chest revealed multiple cavitary pulmonary nodules throughout the pulmonary parenchyma (figure, B). Blood cultures were positive for F necrophorum, and the patient was treated with an appropriate antibiotic. A follow-up CT of the neck 4 weeks later showed a partial resolution of the thrombosis (figure, C).

In the presence of appropriate clinical features, the clinician should consider Lemierre's syndrome when cross-sectional imaging of the neck and chest demonstrates a thrombosed internal jugular vein and multiple septic emboli.

References

(1.) Gormus N, Durgut K, Ozergin U, et al. Lemierre's syndrome associated with septic pulmonary embolism: A case report. Ann Vasc Surg 2004; 18:243-5.

(2.) Sagowski C, Koch U. [Lemierre syndrome: Thrombosis of the internal jugular vein after tonsillectomy]. HNO 2004;52:251-4.

(3.) Weesner CL, Cisek JE. Lemierre syndrome: The forgotten disease. Ann Emerg Med 1993;22:256-8.

David Kirsch, MD; Devin Tighe, MD; Michael G. D'Antonio, MD; Enrique Palacios, MD, FACR

From the Department of Radiology, Louisiana State University Health Sciences Center and VA Medical Center, New Orleans.

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