Central nervous system complications of Lemierre’s syndrome: A case report and recent literature review

• Published in: Journal of Immunology, Allergy and Infection in Otorhinolaryngology Vol. 3; no. 4; pp. 169 - 177
• Main Authors: Maeda, Yasunori, Ueno, Tatsuya, Hara, Ryutaro, Matsushita, Daisuke, Ochiai, Shuya, Ota, Shuji, Kudo, Naomi, Matsubara, Atsushi
• Format: Journal Article
• Language: English
• Published: Japan Society of Immunology, Allergology and Infection in Otorhinolaryngology 2023
• Subjects: central nervous system complications; encephalitis; hemichorea; Lemierre’s syndrome; psychiatric symptoms
• ISSN: 2435-7952
• DOI: 10.24805/jiaio.3.4_169

Lemierre’s syndrome is characterized by oropharyngeal infection, thrombophlebitis of the internal jugular vein, systemic organ thromboembolism, and a high mortality rate. The most involved distant sites are the lungs, joints, bones, skin, and soft tissue. Central nervous system (CNS) complications occur in 3% of cases. A 62-year-old male was rushed to our emergency department due to chills and immobility. Contrast-enhanced computed tomography showed a right parapharyngeal space abscess, which was drained. Thereafter, antibiotic therapy was started. Blood and abscess cultures on admission revealed Streptococcus constellatus. After admission, hemichorea and psychiatric symptoms appeared. Cerebrospinal fluid examination and contrast-enhanced magnetic resonance imaging revealed meningitis, encephalitis, subdural abscess, and sigmoid sinus thrombosis. In addition to antibiotic therapy, anticoagulation therapy was started, and thrombosis was resolved. Hemichorea and psychiatric symptoms were thought to be caused by inflammatory spillover to the subthalamic nucleus. Although hemichorea improved, psychiatric symptoms persisted. When treating Lemierre’s syndrome, physicians should be aware of the possibility of CNS complications.