Lemierre’s syndrome: a pain in the neck with far-reaching consequences

Abstract

Lemierre's syndrome is a potentially life-threatening consequence of oropharyngeal and ear infections and often results in critical care admission and even intubation. Due to the multisystem manifestation, multiple teams may initially be involved in the care, some of which may be unfamiliar with the features and usual clinical course. This report describes a case in a 36-year-old woman with the classic features of internal jugular vein thrombosis and septic emboli to the lungs secondary to an oropharyngeal infection. Treatment comprised antibiotic therapy, anticoagulation and fluid resuscitation, and was carried out in a high dependency unit setting. At follow-up 3 months after discharge, the patient was well with no residual symptoms off all treatment. During the events of this case, it became apparent that while ear, nose and throat and infectious diseases team members were relatively familiar with the condition, other departments including the critical care team were less so.

Late presentation of ‘Lemierre’s syndrome’: how a delay in seeking healthcare and reduced access to routine services resulted in widely disseminatedFusobacterium necrophoruminfection during the global COVID-19 pandemic

“…4 Though some articles describe respiratory failure requiring ventilation as uncommon, 4 other studies and case reports recommend involvement of the critical care team at an early stage to ensure adequate monitoring and support, with one study reporting intubation in up to 37% of cases. 10 The role for anticoagulation in Lemierre's syndrome remains unclear. 11 While anecdotal reports suggest a reduced risk of septic embolic events arising from the IJV thrombosis with anticoagulation, 3 other studies suggest that anticoagulation be reserved for patients with retrograde progression of thrombus, as most do well without.…”

“…Though some articles describe respiratory failure requiring ventilation as uncommon, 4 other studies and case reports recommend involvement of the critical care team at an early stage to ensure adequate monitoring and support, with one study reporting intubation in up to 37% of cases. 10 …”

Septic emboli of the lung due to Fusobacterium necrophorum, a case of Lemierre's syndrome

“…It should be suspected in patients with antecedent pharyngitis, neck pain, respiratory distress, septic pulmonary emboli, and persistent fever despite antimicrobial therapy [9]. Respiratory symptoms have, on occasion, been cited as the presenting complaint for some individuals [10]. Progression is often rapid with pleural effusion and empyema common even with early antibiotic therapy [10].…”

“…Respiratory symptoms have, on occasion, been cited as the presenting complaint for some individuals [10]. Progression is often rapid with pleural effusion and empyema common even with early antibiotic therapy [10]. The severity of respiratory consequences from Lemierre's syndrome is such that chest drain insertion and intubation may be required to combat worsening respiratory failure [10].…”

Lemierre's syndrome: One rare disease-Two case studies

“…For both cases, patients experienced septic thrombophlebitis, and no parenteral anticoagulation was initiated, as the medical team felt that management of infection was adequate. Penicillin is a potential option if susceptibility shows sensitivity to it . Metronidazole, along with a beta‐lactam antibiotic for a total of 6 weeks is the recommended regimen for the management of Lemierre's syndrome.…”