Lemierre’s Syndrome: A Case of Life-Threatening Infection From Family Medicine Practice

Abstract

The use of antibiotic therapy has led to a major transformation in medicine with a substantial reduction in mortality. Due to the adverse effects associated with inappropriate antibiotic use, antibiotic stewardship interventions have been promoted to improve antibiotic prescription. However, delayed antibiotic therapy, when clinically needed, may result in increased morbidity. Here, we report the case of a previously healthy young man with an untreated acute upper respiratory infection for two weeks, who presented with headache and fever. Physical examination suggested meningitis as evident by neck stiffness and positive Kernig sign. Purulent tonsilitis was also noted. Laboratory findings showed leukocytosis and elevated inflammatory markers. The patient underwent a computed tomography scan to rule out space-occupying lesions prior to lumbar puncture. The scan revealed thrombophlebitis of the left internal jugular vein that extended to the dural venous sinuses. Magnetic resonance imaging confirmed the intracranial dissemination of the disease. Such findings conferred the diagnosis of Lemierre’s syndrome. The patient was admitted to the intensive care unit where he received systemic anticoagulation and prolonged intravenous antibiotics. He developed a good response and was discharged with no residual deficits after six weeks of hospitalization. Lemierre’s syndrome is a serious infection that develops after a pharyngeal infection. Considering the high mortality rate of untreated Lemierre’s syndrome, physicians should keep a high index of suspicion for this condition when they encounter a patient with upper respiratory tract infection with clinical or radiological findings consistent with internal jugular thrombophlebitis.

Lemierre Syndrome: A Diagnosis behind the Veil

“…Tis perspective is also refected in the only retro-perspective study available that studied about 700 cases of LS from 2000 to 2017 and concluded that there are no disease-specifc elements of concern regarding the safety of anticoagulation in LS [12]. From our analysis of 26 LS cases from 2016 to 2021, anticoagulation was used in 76% of cases and the average duration was 9.8 weeks (ranging from 1 week to 16 weeks; Table 2 [4,17,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][41][42][43][44]. In our case, due to the absence…”

“…Regarding the duration of antibiotics, Riordan, 2007, referenced an estimate of 9 to 84 days with an average of 42 days [2]. We have analyzed 26 cases of LS from 2016 to 2021, and the average antibiotics duration was 5.3 weeks (Table 2) [4,17,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][42][43][44]. In clinical practice, due to the lack of an established guideline, the duration and selection of antibiotics highly varied based on clinical responses in patients.…”