Lemierre's Syndrome - A rare cause of disseminated sepsis requiring multi-organ support

Abstract

Lemierre's syndrome is a rare complication of acute pharyngitis characterised by septicaemia with infective thrombophlebitis of the internal jugular vein, most commonly due to Fusobacterium necrophorum. It characteristically affects healthy young adults causing persistent pyrexia and systemic sepsis presenting several days after an initial pharyngitis. Septic emboli seed via the bloodstream to distant sites including the lung, joints, skin, liver, spleen and brain. Prolonged antimicrobial therapy is required and admission to intensive care common. This once rare condition is increasing in incidence but awareness amongst clinicians is low. We present a classic case in a young man who developed multi-organ failure requiring intensive care support and describe the epidemiology, pathophysiology, microbiology, clinical features and management of the disease.

Keywords: Fusobacterium necrophorum; Lemierre syndrome; postanginal sepsis; thrombophlebitis.

Figure 1.

Ultrasound image showing thickened, abnormal left internal jugular vein with no flow on Doppler and for comparison the normal right internal jugular vein.

Figure 2.

Cross section from CT scan showing extensive bilateral septic embolic in addition to changes consistent with acute respiratory distress syndrome.