Lesson of the month 1: Lemierre's syndrome: a reminder of the 'forgotten disease'

Clin Med (Lond). 2018 Feb;18(1):100-102. doi: 10.7861/clinmedicine.18-1-100.

Abstract

Lemierre's syndrome is a condition characterised by suppurative thrombophlebitis of the internal jugular (IJ) vein following a recent oropharyngeal infection, with resulting septicaemia and metastatic lesions. It is strongly associated with Fusobacterium necrophorum, a Gram-negative bacilli. Key to early diagnosis is awareness of the classical history and course of this illness, and therefore to ask about a history of recent oropharyngeal infections when a young patient presents with fever and rigors. Diagnosis can be confirmed by showing thrombophlebitis of the IJ vein, culturing F necrophorum from normally sterile sites or demonstrating metastatic lesions in this clinical setting. The cornerstone of management is draining of purulent collection where possible and prolonged courses of appropriate antibiotics. In this article, we review a case study of a young man with Lemierre's syndrome and discuss the condition in more detail.

Keywords: Fusobacterium necrophorum; Lemierre; Lemierre’s syndrome; suppurative thrombophlebitis.

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents / administration & dosage
  • Drainage / methods*
  • Early Diagnosis
  • Fusobacterium necrophorum / isolation & purification*
  • Humans
  • Jugular Veins / diagnostic imaging*
  • Lemierre Syndrome* / diagnosis
  • Lemierre Syndrome* / etiology
  • Lemierre Syndrome* / physiopathology
  • Lemierre Syndrome* / therapy
  • Male
  • Medical History Taking
  • Metronidazole / administration & dosage*
  • Penicillin G / administration & dosage*
  • Peritonsillar Abscess* / complications
  • Peritonsillar Abscess* / diagnosis
  • Peritonsillar Abscess* / microbiology
  • Peritonsillar Abscess* / surgery
  • Sepsis / diagnosis
  • Sepsis / etiology
  • Thrombophlebitis / diagnosis
  • Thrombophlebitis / etiology
  • Treatment Outcome
  • Ultrasonography, Doppler / methods
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Metronidazole
  • Penicillin G