Lemierre syndrome involving external jugular vein

Abstract

Case: A 74-year-old woman with a week-long history of cold symptoms was diagnosed with Lemierre syndrome that involved her left external jugular vein.

Outcome: The patient was successfully treated with 4 weeks of antibiotics and anticoagulant treatment. Typical cases of Lemierre syndrome involve only the internal jugular vein. The external jugular vein is anatomically distant from the pharyngolaryngeal space and usually does not receive blood or lymphatic flow from there. Thus, Lemierre syndrome ordinarily does not involve the external jugular vein and clinical characteristics of external jugular vein-involving Lemierre syndrome have not been uncovered, mainly due to its rarity. Based on our review, it would not much differ from those of typical cases.

Conclusion: Considering the potential severity and mortality, more attention should be paid to this potentially fatal disease that may demonstrate atypical manifestation, as shown in this case. Accumulation of cases would be needed for further understanding.

Keywords: External jugular vein (EJV); Fusobacterium; Lemierre syndrome; jugular vein suppurative thrombophlebitis; septic pulmonary emboli (SPE).

Figure 1

Chest computed tomography in a 74‐year‐old woman with a week‐long history of cold symptoms. Small peripheral nodules suggestive of septic emboli were seen bilaterally on admission (A), and massive pleural effusion emerged with the multiple emboli on day 2 (B).

Figure 2

Gross appearance and contrast‐enhanced computed tomography of the neck in a 74‐year‐old woman with a week‐long history of cold symptoms. Redness and swelling of her left neck along with sternocleidomastoid muscle appeared after admission (A). The thrombus formation and perivascular contrast enhancement, indicating thrombophlebitis, was seen inside the left external jugular vein (arrows) (B, upper slice; C, lower slice). The left internal jugular vein was totally intact and there was no abscess forming around the veins.