Lemierre’s syndrome following perianal abscess: A case report

• Published in: International journal of surgery case reports Vol. 45; pp. 51 - 55
• Main Authors: Aljarrah, Qusai, Khazaleh, Yara, Al-Jarrah, Mooath, Oldbury, Jordan W., Abou-Foul, Ahmad K.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.01.2018; Elsevier
• Subjects: Case Report; Internal jugular vein; Lemierre’s syndrome; Perianal abscess; Sepsis; Thrombophlebitis; Sepsis; Thrombophlebitis; Internal jugular vein; Perianal abscess; Lemierre’s syndrome
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2018.03.012

•Lemierre’s syndrome is characterized by suppurative thrombophlebitis of the IJV.•It is a rare complication to sepsis in the head and neck region or the digestive and uro-genital tracts.•Symptoms include painful unilateral neck swelling and septicaemia.•Early intensive antimicrobials treatment is important for favourable outcome. Lemierre’s syndrome (LS) is a rare and life-threatening condition characterized by suppurative thrombophlebitis of the internal jugular vein (IJV), and a history of head and neck (H&N) sepsis. LS is usually caused by Fusobacterium necrophorum, which is part of the normal flora in the oro-pharynx, and the digestive and urogenital tracts. We here report the first case of LS following perianal sepsis. A 60-year-old man with a painful left neck swelling, dysphagia and worsening sepsis was referred from a peripheral unit where he had an incision and drainage of a perianal abscess a week earlier. Urgent Doppler ultrasound and computed tomographic scans demonstrated suppurative thrombophlebitis of the left IJV, and the patient was subsequently commenced on intravenous Piperacillin/Tazobactam and heparin. The symptoms gradually improved, and the patient was eventually discharged on the 10th day. Vigilant examination of the H&N region searching for a primary source is paramount, but LS following infections in the gastrointestinal or uro-genital tracts has also been described. A high index of suspicion is required for diagnosis, especially in patients with unresolving pharyngitis with a unilateral neck swelling, and septicaemia. Early resuscitation and treatment with broad-spectrum parenteral antimicrobials are important for favourable outcome. LS is well known to specialists in the H&N region, but other disciplines like general surgery, urology, or obstetrics and gynaecology might also rarely encounter the disease. We present a case of LS complicating a perianal abscess that was successfully treated with good outcome.