[Lemierre syndrome - a frequently overlooked infectious disease]

Abstract

History and clinical findings: We report the case of a 30 years old man presenting with cough and a sore throat. The physical examination showed a painful neck, a scleral icterus, inflammation of the posterior pharyngeal wall and tonsils.

Investigations: Initial laboratory studies revealed an increase in white blood cells, a pronounced reduction of platelets, an elevated CRP and renal failure. Ultrasound examination of his neck showed a thrombosis of the jugular vein. Blood cultures were drawn and led to the identification of fusobacterium necrophorum.

Diagnosis: Lemierre's Syndrom accompanied by purulent abscess-forming thrombophlebitis of the right external jugular vein.

Treatment and course: Antibiotic therapy was started with ceftazidime plus levofloxacin and was adjusted to ampicillin plus clindamycin. As resistance to ampicillin was detected, therapy was readjusted to meropenem. Inflammation, renal parameters, transaminases and bilirubin decreased. The patient improved clinically and was discharged after 19 days in hospital.

Conclusion: The Lemierre's Syndrome is a rare and often underdiagnosed septic disease followed on pharyngeal infections leading to purulent thromboplebitis of small veins. An appropriate antibiotic therapy is mandatory for a successful treatment of this disease.