[Pleuro-pneumonia revealing septic thrombophlebitis of the jugular vein: Think about the Lemierre's syndrome]

Abstract

Introduction: Infection by Fusobacterium necrophorum, a Gram negative anaerobic bacteria, can lead to the development of Lemierre's syndrome, an uncommon but potentially fatal infection of the internal jugular vein. Since the introduction of antibiotics, the morbidity and mortality associated with this syndrome have been dramatically reduced. This syndrome is characterized by a pharyngeal infection, which leads to the development of septic thrombophlebitis of the internal jugular vein with septic emboli, which usually spread into the lung. Sometimes the syndrome can be revealed by other unusual clinical symptoms.

Case report: We present the case of a young patient with an atypical pleural infection associated with pharyngeal infection and thrombosis from the internal jugular vein.

Conclusions: The diagnosis of Lemierre's syndrome is mainly clinical, based on a range of suggesting symptoms. Confirmation and monitoring of the condition can be done by ultra-sound and/or contrast enhanced computed tomography. Treatment is based on long-term, high-dose antibiotic therapy and eventually surgical drainage of the infected collection with surgical excision of the internal jugular vein where there is extensive thrombosis. The important message is that in the context of a young patient without comorbidity, who presents with a significant infectious pleurisy, it is important to consider this clinical complication.

Keywords: Empyema; Empyème; Fusobacterium necrophorum; Fusobacterium nécrophorum; Lemierre syndrome's; Sepsis; Syndrome de Lemierre; Thrombophlebitis; Thrombophlébite.