Lemierre’s syndrome: current perspectives on diagnosis and management

Abstract

This is a systematic review of cases with Lemierre’s syndrome (LS) in the past 5 years. LS is characterized by sepsis often evolving after a sore throat or tonsillitis and then complicated by various septic emboli and thrombosis of the internal jugular vein. Symptoms include sepsis, pain, and/or swelling in the throat or neck, as well as respiratory symptoms. Laboratory findings show elevated infectious parameters and radiological findings show thrombosis of the internal jugular vein and emboli in the lungs or other organs. The syndrome is often associated with an infection with Fusobacterium necrophorum. We found a total of 137 cases of LS, of which 47 were infected with F. necrophorum and others with Staphylococcus and Streptococcus. Complications of this rare but severe disease included osteomyelitis, meningitis, and acute respiratory distress syndrome. Mortality was extremely high in the pre-antibiotic era but has diminished with the advent of antibiotics. This review showed a mortality rate of only 2% of which none of the cases involved fusobacteria. Duration of treatment varied; a 4–6-week course of carbapenem or piperacillin/tazobactam in combination with metronidazole was optimum. Other treatment options included anticoagulants in 46% of cases, which is unwarrantedly high, as to date, no evidence of the positive effects of anticoagulants in LS exists. Only two cases had ligation of the internal jugular vein performed. This review confirms the rare, but severe aspects of LS. Mortality from LS in this day and age appears to be low, however the syndrome is difficult to recognize, and still requires the full attention of the clinician.

Antibiotic use as a marker of acute infection and risk of first and recurrent venous thrombosis

“…Additional proof that infections cause thrombosis comes from associations between infection and subsequent thrombosis in the same specific site, reported for various morbidities, e.g. Lemierre syndrome and cerebral vein thrombosis (Korathanakhun et al , ; Johannesen & Bodtger, ; Yildiz et al , ).…”

Thoracic pain associated with an odontogenic infection: An unusual Lemierre's syndrome

“…However, the study that indicated that 64% of patients used anticoagulants for treating such infections did not distinguish between the different types of thrombosis, such as thrombosis of the cavernous sinus, which may require a more aggressive treatment than thrombosis of the internal jugular vein. 17 In our report, the use of enoxaparin with a full dose of warfarin was initiated during hospitalization, and the patient was prescribed oral warfarin at discharge.…”

Lemierre’s syndrome: a rare cause of sepsis presenting with an absence of throat symptoms

“…An otolaryngologist will be suspicious of Lemierre’s syndrome in patients with severe sepsis from tonsillitis or quinsy that is not responding to antibiotic therapy. It is very rare to have complete resolution of pharyngitis symptoms prior to symptoms from metastatic infection 6. This can mask the diagnosis.…”

“…This can lead to cavitating lung lesions and empyema despite appropriate antibiotic treatment, as evidenced by this case. Anticoagulation treatment was therefore commenced in an attempt to stop the patient developing respiratory failure from further septic emboli 6. Some authors have suggested commencing anticoagulation therapy if little clinical improvement within 2–3 days of starting treatment or evidence of IJV thrombosis propagation 8 9.…”