Lemierre\'s Syndrome: A Retrospective Case Series

Abstract

In most of the cases, oropharynx is the primary site of infection and exudative tonsillitis may be present in many cases, and sometimes just mild hyperemia and ulcers in the oropharynx and peritonsillar area are noted in some cases. The general signs are tenderness and hyperemia over the angle of jaw and pain with neck movement, which is sometimes associated with IntroductIonIn 1936, André Lemierre described a syndrome with post-anginal septicemia, which was complicated with thrombosis of the IJV and the presence of distant septic emboli in the patient's bloodstream. 1,2 It has gained a special status due to few cases coming to light and as a "forgotten" and a condition which is often missed in diagnosis resulting in various complications and poor patient outcomes and sometimes may result in mortality. [3][4][5] André Lemierre explained that septic emboli reaching IJV could originate from many sites such as nasopharynx, oral cavity, ear having otitis media, mastoiditis, uterus having purulent endometritis, and appendicitis. 4 The involvement of IJV provides a pathway for the spread of infection through bloodstream. The symptoms are tenderness in neck region, pain, fever with chills and rigors, and erythema in pharyngeal and peritonsillar region on oropharyngeal examination. Since the IJV is involved, the infection can potentially undergo hematogenous spread. The infection generally spreads to spleen, liver, kidney, heart, and brain. 6,7 Lemierre's syndrome can be diagnosed based on clinical symptoms, multitude of blood series, and imaging. Since it is an infectious condition, the treatment involves systemic antibiotic therapy, and early administration of broad-spectrum antibiotics in high dose becomes necessary for prevention of complications and systemic spread of infection. 8,9 EpIdEmIologyLemierre's syndrome is generally seen in young adults. 10 According to a study carried out in Denmark, there was an annual incidence