Cervicofacial Cellulitis due to Staphylococcus aureus with Jugular Vein Thrombosis and Multiple Septic Pulmonary Embolism: A Lemierre-Like Syndrome

Abstract

This is the case of a 28-year-old male patient with no particular pathological history who presented with an inflammatory swelling of the right cheek with pus in an infectious context. Cervicofacial CT with contrast injection allowed the diagnosis of a right cervicofacial cellulitis, associated with a jugular venous thrombosis extending to the superior vena cava. It also revealed septic pulmonary metastases in the form of multiple excavated pulmonary nodules. The analysis of the pus sample allowed the isolation of Staphylococcus aureus as the causative germ. This led to the diagnosis of a Lemierre-like syndrome, which is a variant of the Lemierre syndrome. Despite appropriate antibiotic treatment and anticoagulation, the patient died after 16 days of hospitalization.

Figure 1

Photograph showing the right jugal swelling with fistulizations under the right maxilla and cervical leaving pus (white arrows).

Figure 2

Cervical CT scan with contrast injection. (a) Axial view showing right masticatory area fluid collection (blue arrow). (b) Axial view showing fistulous path to the skin (red arrow). (c) Coronal view showing heterogeneous content of the collection with air bubbles (white arrows).

Figure 3

Cervicothoracic CT scan with contrast injection. (a) Axial view at cervical level showing occlusive thrombosis of the right jugular vein (blue arrow). (b) Axial view at thoracic level showing thrombosis of the right superior vena cava (red arrow). (c) Sagittal view showing the thrombosis extended along the right jugular vein to the superior vena cava (blue arrow).

Figure 4

Thoracic CT scan with contrast injection. (a, c, and d) Axial, coronal, and sagittal views in the lung window showing multiple bilateral excavated nodules. (b) Axial view in mediastinal window showing left pleural fluid effusion with passive atelectasis of the lower lobe.