Lemierre’s syndrome: a forgotten life-threatening entity

• Published in: BMJ case reports Vol. 13; no. 10; p. e236201
• Main Authors: Gama, Rita, Sousa, Manuel, Castro, Fernanda, Condé, Artur
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 30.10.2020; BMJ Publishing Group
• Series: Case report
• Subjects: Abscesses; Adolescent; Antibiotics; Case reports; Collections; Diagnosis, Differential; Dyspnea; Ears & hearing; Edema; Female; Fever; Fusobacterium Infections - complications; Fusobacterium Infections - microbiology; Fusobacterium necrophorum - isolation & purification; Humans; Infections; Jugular Veins; Lemierre Syndrome - complications; Lemierre Syndrome - diagnosis; Literature reviews; Lungs; Medical imaging; Otolaryngology; Pain; Pediatrics; Physicians; Rare Disease; Sepsis - diagnosis; Sepsis - etiology; Thromboembolism; Thrombophlebitis - diagnosis; Thrombophlebitis - etiology; Thrombosis; Tomography, X-Ray Computed; Tonsillitis; Ultrasonic imaging; Ultrasonography, Doppler; Veins & arteries; infections; nose and throat; ear
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-236201

Lemierre’s syndrome is a very rare but potentially fatal condition. It mainly affects adolescents and young adult males, and usually arises as a serious complication of pharyngitis or peritonsillar abscess. It is characterised by the triad of internal jugular vein septic thrombophlebitis, septic emboli (mostly pulmonary) and the isolation of the agent ‘Fusobacterium necrophorum’ in sterile fluids. In this report, it is described a case in which the nonspecific and subtle clinic made the diagnosis difficult to reach. In fact, only the dissociation between flu-like symptoms and the presence of significant changes in the blood tests (suggestive of acute bacterial infection), led to the request for imaging tests, which proved to be essential for the final diagnosis and subsequent control of the disease. This case report aims to increase the awareness among Ear, Nose and Throat (ENT) residents, paediatricians and family doctors about the existence of this entity and its potential life-threatening nature.