Lemierre Syndrome

Abstract

Lemierre's syndrome is an uncommon complication of pharyngitis in the United States and caused most commonly by the bacterium Fusobacterium necrophorum. The syndrome is characterized by a history of recent pharyngitis followed by ipsilateral internal jugular vein thrombosis and metastatic pulmonary abscesses and is a disease for which patients will seek medical care and advice. As most patients are admitted to the hospital under internal medicine, practitioners should be familiar with the usual signs and symptoms of Lemierre's syndrome along with its diagnosis and treatment. Controversy involves the choice and duration of antimicrobial therapy used for treatment and anticoagulation therapy for internal jugular vein thrombosis. As the diagnosis and management of this syndrome has generated controversy, an updated review of the literature and treatment recommendations may be helpful for providing optimal care for patients with this often unrecognized and confusing infection.

To anticoagulate? Controversy in the management of thrombotic complications of head & neck infections

“…73 These additional indications for anticoagulant use were consistent with the management practices in our 11 cases, as was the suggested duration of treatment (average 105.8 days, range 21-180). However, our patients were not converted to warfarin.…”

“…Other situations that may warrant anticoagulation include underlying thrombophilia, 11 cerebral infarct, or refractory septic thrombophlebitis. 73 Arterial ischemic stroke is another complication that may prompt anticoagulation, and one patient in our case series did suffer an MCA infarct with lasting neurologic deficits.…”

“…73 They suggest LMWH with conversion to warfarin, targeted to an INR of 2-3, for 3 months in patients in whom anticoagulation is indicated.…”

Neck pain and swelling in a young man

“…Lemierre syndrome is a rare but distinct type of thrombophlebitis, with an estimated incidence of 0.8–3.6 cases per million per year 1. It is characterised by a suppurative thrombophlebitis of the IJ caused by the spread of oropharyngeal infections into the parapharyngeal space.…”

Lemierre Syndrome Complicating Pharyngotonsilitis in a Young Male: A Case Report

“…It is more commonly reported in healthy young adults with a reported incidence of less than 1 per million of the population [1,3]. In 87% of cases, there is an antecedent pharyngotonsilitis, with subsequent Fusobactrium necrophorum invasion of the para and retropharyngeal spaces [4,5]. Other microbes implicated in the aetiopathogenesis of Lemierre's include anaerobes and gram negatives like other Fusobacterium species, Bacteroides fragilis, Bacteroides melaninogenicus, Peptostreptococcus spp, Porphyromonas asaccharolytica and Eikenella corrodens [2,6,7].…”