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

Abstract

Lemierre's syndrome is characterized by thrombophlebitis in the internal jugular vein after an infection in the area of the head or neck, mostly in the form of pharyngitis and/or tonsillitis. It may also result from less common conditions, such as odontogenic infections, but this condition has not often been reported in the dental literature. The syndrome's main etiological agent is Fusobacterium necrophorum, and it most commonly occurs in young adults. This study reports the clinical case of a 34‐year‐old female patient of poor socioeconomic status with a history of pericoronitis, who reported having a chest pain that radiated to the upper limbs, along with dyspnea. The computed tomography of her neck provided evidence of an acute thrombus in the right internal jugular vein. The treatment comprised antibiotic and anticoagulant therapy in addition to the extraction of her third molar and some residual roots. This report highlights the perils of systemic complications through dental infection, including the risk of death.

Serious Complications and Treatment Strategies Associated with Odontogenic Infections

“…It is a complication that can rarely be seen with the progression of complications such as sepsis and septic embolization of the lung secondary to anaerobic infection in the head and neck area, but its clinical course is fatal. 77 , 78 …”

“… 82 This syndrome is known to be more common in young adults; it is seen at lower rates, especially with the widespread use of antibiotics to treat streptococcal pharyngitis. 78 …”

“…Although pharyngitis and tonsillitis are frequently seen in patients who develop LS, reports of patients without upper respiratory tract infections have also been reported. 78 , 79 , 85 Criteria for diagnosing LS are listed as the primary infection area localized in the head and neck region, thrombosis/thrombophlebitis or metastatic lesions observed in the IJV or the veins in the region, and the isolation of F. necrophorum from a sterile area or its detection in blood culture. 86 …”

“… 88 A case history report in the literature reported that the patient was treated in the hospital for 2 months, 20 days of which were in intensive care, and that the patient was also given anticoagulants along with broad-spectrum antibiotics. 78 …”

Lemierre’s Syndrome in the 21st Century: A Literature Review

“…A recent systematic review found that 73% had experienced signs or symptoms of a recent acute oropharyngeal infection, though other sites of infection including the ear, lower respiratory tract, and neck were also reported [ 9 ]. Other primary infections such as cellulitis [ 33 ], perianal abscess [ 34 ], and pericoronitis have also been previously reported within the literature [ 35 ].…”