Lemierre Syndrome

What is Lemierre Syndrome?

Lemierre Syndrome is Septic Thrombophlebitis of the Internal Jugular Vein. The syndrome is comprised by:

1 Bacteremia with Fusobacterium necrophorum

2 Septic thrombosis of the Internal Jugular Vein

3 Septic emboli, from the Internal Jugular Vein, most often to the lungs

Who does Lemierre Syndrome affect and what is the pathophysiology and progression?

1 Young, healthy adults are typically affected, ages 16-24.

2 Fusobacterium necrophorum, an anaerobic gram negative bacterium, is the most common pathogen and often colonizes the oropharynx, though other pathogens are possible.

3 Infection usually begins as a tonsillitis and spreads to the lateral pharyngeal recess, which then leads to thrombosis and infection of the internal jugular vein.

4 Bacteremia ensues and septic emboli to the lungs are common, presenting as multiple, nodular consolidative lesions in both lungs.

Symptoms and signs can include:

1 Antecedent sore throat,

2 Followed by Septic Thrombophlebitis of the Internal Jugular Vein 1-3 weeks later, possibly manifesting as fever, trismus, and unilateral neck pain and swelling. A palpable cord in the neck is rare.

3 Septic emboli to the lungs, which may result in dyspnea, hemoptysis, or pleuritic chest pain.

Treatment includes:

1 Intravenous antibiotics for a period of 4-6 weeks with a beta-lactam antibiotic such as Ceftriaxone, 2 grams ivpb daily, plus metronidazole 500 mg iv tid initially, and then narrowing the antibiotics based on blood culture results. Resistance to metronidazole by Fusobacterium necrophorum is rare and that is the usual main culprit.

2 Anticoagulation is controversial and should be individualized. Some experts suggest no anticoagulation initially followed by institution of anticoagulation for continued fever, bacteremia, or progressive thrombosis.