Patients typically present with high fevers, neck pain, and pulmonary symptoms. Lemierres syndrome the western journal of emergency medicine. Fusobacterium necrophorum is the most common pathogen isolated from the patients. Lemierres syndrome, fusobacteria, postanginal sepsis. The ensuing bacteraemia is complicated by septic emboli to a range of sites such as lung, joints, and.
Lemierre s syndrome is a condition characterized by thrombophlebitis of the internal jugular vein and bacteremia caused by primarily anaerobic organisms, following a recent oropharyngeal infection. Lemierres syndrome following extraction of wisdom teeth. Human necrobacillosis, with emphasis on lemierres syndrome. This article cites 30 articles, 5 of which you can access for free at. A thrombus in his internal jugular vein lemierres syndrome and an abscess in his obturator internus.
In the 1960s and 1970s, lemierres syndrome became a rare phenomenon with the proliferation of penicillin in the treatment of pharyngitis. Jan 08, 2019 lemierre syndrome is a rare and potentially lifethreatening complication of bacterial infections that usually affects previouslyhealthy adolescents and young adults. Lemierres syndrome necrobacillosis postgraduate medical journal. It most often develops as a complication of a bacterial sore throat infection in young, otherwise healthy adults. This syndrome described at the beginning of the 20th century combines oropharyngeal infection complicated with septic thrombosis of the internal jugular vein and. In 1936, lemierre published a series of 20 cases of anaerobic postanginal sepsis. In retrospect, this case of lemierre syndrome was classic given the oropharyngeal source of infection, significant lung infection, sepsis, the growth of f.
Children who were aged from birth to 21 years and had received a diagnosis of jvt and lemierres syndrome at the childrens hospital denver, co be. 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. Lemierres syndrome is a rare but lifethreatening, bacterialinduced condition that can cause severe sepsis, acute respiratory distress syndrome, and multiorgan failure 1, 2. It is most commonly seen in otherwise healthy adolescents and young adults. Jul 17, 2006 lemierre s syndrome presents a classic but exceptional clinical picture 0. This syndrome is characterized by a throat infection complicated with septic thrombophlebitis of the internal jugular vein and septic emboli mainly to the lungs. Images in clinical medicine from the new england journal of medicine lemierres syndrome. We describe an unusual case of a previously healthy 58yearold male with lemierres syndrome. Lemierre s syndrome refers to infectious thrombophlebitis of the internal jugular vein. Fever is the most common physical finding reported, present in 92% to 100% of cases, followed by pharyngitis or peritonsillar abscess and neck mass 2, 7, 9, 10, 1218, 23, 24. At this time, the risks and benefits of providing either therapy must be weighed against the potential complications of incompletely treating septic thrombosis. Oct 23, 20 lemierres syndrome is a condition characterized by thrombophlebitis of the internal jugular vein and bacteremia caused by primarily anaerobic organisms, following a recent oropharyngeal infection. If you have problems viewing pdf files, download the latest version of adobe reader. Lemierres syndrome a rare cause of disseminated sepsis.
He had been a resident in the united kingdom for a year. Lemierres syndrome is a severe illness caused by the anaerobic bacterium. It most often develops as a complication of a bacterial sore throat infection in. Other treatment options included anticoagulants in 46% of cases, which is. Diagnosis is often confirmed by identification of thrombophlebitis of the internal jugular vein and growth of anaerobic bacteria on blood culture. Lemierre syndrome treat with antibiotics, anticoagulants or. Pdf lemierres syndrome is a condition characterized by thrombophlebitis of the internal jugular vein and bacteremia caused by primarily. It can involve the jugular vein, facial veins and respiratory tract. It mainly affects adolescents and young adult males, and usually arises as a serious complication of pharyngitis or peritonsillar abscess. Treatment includes intravenous antibiotic therapy and drainage of septic foci. Lemierre s syndrome is characterized by septic thrombophlebitis of the internal jugular vein. It typically presents in healthy adolescents or young adults, usually preceded by an oropharyngeal infection, with the most common offending pathogen being fusobacterium necrophorum.
Apr 11, 2014 anticoagulation in lemierres syndrome remains controversial but should be considered if thrombosis extension is noted clinically. We present another case of lemierre s syndrome caused by pantonvalentine leucocidin pvlpositive methicillinsusceptible staphylococcus aureus mssa in a healthy 18yearold indian student. Since the advent of antibiotics, the incidence of lemierre syndrome has reduced significantly, now affecting between 0. Lemierre syndrome most often occurs in young men and there is embolization to the lungs in up to 97% of cases. Infectious complication of upper neck inflammatory processes pharyngitis and pharyngeal abscess and head and neck surgery resulting in subluxation of the atlantoaxial joint. Hagelskjaer kristensen l, prag j 2008 localised fusobacterium. Lemierre syndrome is a potentially fatal complication of oropharyngeal infections that is characterized by jugular vein thrombosis and septic emboli. This has been an uncommon illness in the era of antibiotic therapy, though it has been reported with increasing frequency in the past 15 years. Lemierre syndrome consists of septic thrombophlebitis of the. Nov 01, 2018 lemierre s syndrome is a rare, lifethreatening condition, which may be fatal if not properly treated.
Problems occur when bacteria begin to thrive within abscesses in the throat, leading to deep infections that may reach a major blood vessel called the jugular vein. The aetiological agent is typically anaerobic bacteria of the genus fusobacterium. We report a case of lemierre s syndrome due to fusobacterium nucleatum in a previously healthy 19yearold male. Lemierres syndrome caused by streptococcus pyogenes in an.
Oct 23, 20 the physical exam findings of lemierres syndrome are variable and depend on the extent of metastatic disease table 2. Lemierre s syndrome is characterized by disseminated. Lemierre s syndrome is the septic embolic complication of recent pharyngeal illness. Necrobacillosis, with a focus on lemierres syndrome. First described by coumont and cade in 1900, it is named for a french physician named andre lemierre after he described 20 cases in 1936. Aug 01, 2020 lemierre s syndrome is commonly seen among young adults. It is characterized by thrombosis of the internal jugular vein leading to the systemic circulation of septic emboli. It also is called postanginal sepsis, as well as necrobacillosis.
A case of lemierres syndrome in intensive care unit. Rarely, the etiology of this syndrome may be tooth extraction. The common pathogen identified is fusobacterium necrophorum. Since the introduction of antibiotics, lemierre s syndrome has become relatively rare and is usually unsuspected until blood culture results are available. Lemierres syndrome is a very rare but potentially fatal condition. Computed tomography is the imaging method most often used for diagnosis and treatment is basically antibiotic. Fusobacterium necrophorum american academy of pediatrics. Lemierre s syndrome or postanginal septicaemia necrobacillosis is caused by an acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein and frequent metastatic infections. Lemierre syndrome is a rare and potentially lifethreatening complication of bacterial infections that usually affects previouslyhealthy adolescents and young adults. In that series, another patient who died from lemierre syndrome had a high number. Lemierre s syndrome is a rare form of severe sepsis secondary to oropharyngeal infection characterized by septic thrombophlebitis of the internal jugular vein with disseminated infections, with. Prompt clinical diagnosis and treatment with appropriate antibiotics are critical.
Passive range of motion of the elbow was full and pain free. Lemierres syndrome necrobacillosis postgraduate medical. This syndrome is an uncommon but potentially lethal complication of otolaryngological infections. Lemierre syndrome treat with antibiotics, anticoagulants. Ultrasonography is a radiation free and easily available bedside tool, but it has. Lemierre syndrome following oropharyngeal infection. Lemierres syndrome was common in the era before the advent of antibiotics. Lemierre s syndrome is a rare disorder characterized by pharyngitis, tonsillar andor jugular vein thrombophlebitis, and septicemia usually caused by the anaerobic bacteria fusobacterium necrophorum. Our main mission in this fight is to bring awareness of lemierres syndrome to the public.
Today, the incidence of lemierres syndrome is estimated to be 1 per million annually. Lemierres syndrome is a rare condition characterized by septic thrombophlebitis of the internal jugular vein and metastatic abscesses following oropharyngeal infection. Lemierre s syndrome is characterized by disseminated abscesses and thrombophlebitis of the internal. Increased diagnosis of lemierre syndrome and other fusobacterium.
We present a case of lemierre s syndrome in an elderly woman without antecedent oropharyngeal infection, caused by. Over the last few years, there has been a noticeable increase in efforts to identify genetic predispositions that modify the detection of the pathogen by the host or the resultant systemic reaction, efforts that may enhance our. Case presentation a previously healthy 24yearold african american man presented with a 2week history of fever, chills, dyspnea, abdominal pain and vomiting, nonbloody diarrhea, anorexia, and body aches. The interval between the oropharyngeal infection and the onset of the septicaemia is usually short. Lemierres syndrome international journal of emergency. Jan 01, 2017 lemierres syndrome has been shown to be increasing in incidence in the past 20 years with one popular suggesting that said rise occurred from less aggressive antibacterial coverage. Successful management rests on the awareness of the condition, a high index of suspicion, and a multidisciplinary. Over the past 25 years, 85 cases of lemierre s syndrome have been reported in the english literature. This disease refers to thrombophlebitis of the internal jugular vein ijv, which is the result of bacterial sore throat infection usually in the form of pharyngitis that extends into the parapharyngeal space. It most commonly develops in association with a bacterial throat infection, but it may develop in association with an infection involving the ears, salivary glands parotitis, sinuses, or teeth. Lemierre s syndrome is characterized by oropharyngeal infection, usually by fusobacterium necrophorum, followed by septic thrombophlebitis of the internal jugular vein with embolization to the lungs and other organs.
May 18, 2020 lemierre syndrome remains a serious disease even in this millennium with ample antibiotic availability. The infection originates in the throat and spreads via a septic thrombophlebitis of the tonsillar vein and internal jugular vein. Lemierres syndrome is suppurative thrombophlebitis of the jugular vein. Sep 01, 2008 because lemierre s syndrome is so rare, it is difficult to ascertain absolutely the need for either anticoagulation or longterm antibiotic therapy. Genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 toll free. Lemierre s syndrome is a rare and severe sepsis that can rapidly lead to a lifethreatening condition in the absence of early management. Doppler ultrasonography confirmed thrombosis of both the external and the internal jugular veins. Our case involved thrombosis of the superficial internal jugular vein that developed after wisdom teeth extraction, a. Lemierre s syndrome was featured in the case records of the massachusetts general hospital in the new england journal of medicine, november 20, 2014, vol.
A case report on the recurrence of lemierres syndrome. Lemierres syndrome is a rare complication following an acute oropharyngeal infection. Lemierres syndrome is a rare disease of the head and neck, characterized by an initial infection, usually within the oropharynx, which can develop into a septic thrombophlebitis. A 7yearold child attended our institution with a 1week history of fever and cough. Lemierres syndrome is characterized hy thrombosis of the internaljugularv ein. Lemierres syndrome is a rare but potentially fatal disease caused by oropharyngeal infections. Oct 21, 2019 the classic lemierres syndrome refers to a septic thrombosis of the internal jugular vein, usually caused by a fusobacterium necrophorum infection starting in the oral cavity, and typically complicated by pulmonary emboli. This is the first case report of lemierre s syndrome due to thrombophlebitis of the external jugular vein.
Jones jw, riordan t, morgan ms 2001 investigation of postanginal sepsis and lemierres syndrome in the south west peninsula. Currently, since imaging has a key role in the early diagnosis of this syndrome, the radiologist should be aware of and recognize its manifestations. He occasionally smoked marijuana but had no pets, and denied sick contact or recent travel. Lemierres syndrome is and what risk factors may be involved, and to understand the roles, if any, of antibiotics and anticoagulants in the treatment of this s. Lemierre syndrome genetic and rare diseases information. Analyses manifested leukocytosis 19 000, with a shift to the left, and the chest xray was normal. The patient had a rapid clinical response to anticoagulation and antibiotics, as supported by anecdotal evidence. Bilateral lemierre syndrome secondary to periodontitis.
During the last decades, lemierres syndrome has again been reported more frequently in western. Lemierre s syndrome begins with an infection of the head and neck region, with most primary sources of infection in the palatine tonsils and peritonsillar tissue. The syndrome is characterised by a primary oropharyngeal infection followed by metastatic spread and suppurative thrombophlebitis of the internal jugular vein. Ultrasonography is a radiationfree and easily available bedside tool. Though classically caused by fusobacterium necrophorum, a number of other causative organisms have been reported in literature. Lemierre s syndrome may not be as rare as previously thought. Usually this infection is a pharyngitis which occurred in 87.
This apparent increase in the incidence may be due to antibiotic resistance or changes in antibiotic prescription patterns. Jan 27, 2021 lemierre s syndrome is a possible complication of a severe, untreated throat or tonsil infection. For language access assistance, contact the ncats public information officer. Lemierres syndrome is a severe illness caused by the anaerobic bacterium, fusobacterium necrophorum which typically occurs in healthy teenagers and young adults.
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