Lemierre's syndrome: a pain in the neck with far-reaching consequences

BMJ Case Rep. 2018 Jan 3:2018:bcr2017222723. doi: 10.1136/bcr-2017-222723.

Abstract

Lemierre's syndrome is a potentially life-threatening consequence of oropharyngeal and ear infections and often results in critical care admission and even intubation. Due to the multisystem manifestation, multiple teams may initially be involved in the care, some of which may be unfamiliar with the features and usual clinical course. This report describes a case in a 36-year-old woman with the classic features of internal jugular vein thrombosis and septic emboli to the lungs secondary to an oropharyngeal infection. Treatment comprised antibiotic therapy, anticoagulation and fluid resuscitation, and was carried out in a high dependency unit setting. At follow-up 3 months after discharge, the patient was well with no residual symptoms off all treatment. During the events of this case, it became apparent that while ear, nose and throat and infectious diseases team members were relatively familiar with the condition, other departments including the critical care team were less so.

Keywords: ear, nose and throat/otolaryngology; infectious diseases; intensive care; otolaryngology/ENT; vascular surgery.

Publication types

  • Case Reports

MeSH terms

  • Administration, Intravenous
  • Adult
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use
  • Anticoagulants / administration & dosage
  • Anticoagulants / therapeutic use
  • Diagnosis, Differential
  • Embolism / complications
  • Embolism / microbiology*
  • Embolism / pathology
  • Female
  • Fusobacterium necrophorum / isolation & purification
  • Humans
  • Jugular Veins / pathology*
  • Lemierre Syndrome / diagnosis*
  • Lemierre Syndrome / drug therapy
  • Lemierre Syndrome / microbiology*
  • Neck / pathology
  • Oropharynx / microbiology*
  • Oropharynx / pathology
  • Pain / diagnosis*
  • Pain / etiology
  • Sepsis / complications
  • Sepsis / microbiology*
  • Sepsis / pathology
  • Treatment Outcome
  • Venous Thrombosis / diagnosis
  • Venous Thrombosis / drug therapy
  • Venous Thrombosis / microbiology*
  • Venous Thrombosis / pathology

Substances

  • Anti-Bacterial Agents
  • Anticoagulants