Lemierre's Syndrome: A Case Report

Abstract

Lemierre's syndrome is a rare condition characterized by septic thrombophlebitis of the internal jugular vein secondary to infection of the head and neck region and septic embolization to other organs. The most frequent etiological agent is Fusobacterium necrophorum, a commensal anaerobic gram-negative bacillus of the oral flora. We report the case of a young male who presented with chest pain after a dental procedure. He developed a masseterian phlegmon, thrombosis of the internal jugular vein, and embolization to the lung complicated by empyema. The diagnosis of Lemierre's syndrome was delayed by the negative blood cultures, but full recovery was achieved after appropriate broad-spectrum antibiotic coverage. Our main objective is to highlight the fact that a high clinical suspicion is required to establish the diagnosis of this rare syndrome.

Keywords: fusobacterium necrophorum; jugular vein thrombophlebitis; lemièrre’s syndrome; septic embolism; septic thrombophlebitis.

Figure 1. Thoracoabdominal CT showing pulmonary nodular lesions with central cavitation suggestive of septic embolization

CT: computed tomography

Figure 2. Abdominal CT showing hepatosplenomegaly

CT: computed tomography

Figure 3. Facial CT revealing an abscess adjacent to the left ascending branch of the mandible, within the masseter

CT: computed tomography

Figure 4. Facial CT showing a heterogeneous opacification of the jugular vein compatible with partial thrombosis

CT: computed tomography

Figure 5. Chest X-ray showing a right pleural effusion

Figure 6. Thoracoabdominal CT showing right massive pleural effusion with mild pleural thickening

CT: computed tomography