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Emergency: requires immediate attention
Lemierre syndrome
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Emergency: requires immediate attention

Lemierre syndrome

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Contributors: Neil Mendoza MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

Suppurative jugular thrombophlebitis (also known as Lemierre syndrome, fusobacterial necrotizing tonsillitis, human necrobacillosis, or postanginal sepsis) is a severe infection of the internal jugular vein usually caused by the anaerobic gram-negative rod Fusobacterium necrophorum, a component of the normal oral flora in humans.

A recent systematic review of over 100 patients with this condition reported that most cases presented in the second and third decade of life.

Infection typically begins in the tonsil or the pharynx and then spreads to the lateral pharyngeal space. The infection then invades the carotid sheath by contiguous spread. This leads to jugular vein septic thrombophlebitis.

Patients appear systemically ill at presentation. Fevers and rigors are common, as is tenderness in the anterior cervical triangle. Pharyngitis may not be a prominent symptom. Patients may have dysphagia or lower cranial nerve dysfunction. Laboratory evaluation reveals leukocytosis. Blood cultures are usually positive.

The most commonly isolated organism is F. necrophorum. Other Fusobacterium species and other anaerobic organisms that are part of the normal oral flora, including anaerobic streptococci, have also been implicated. In some cases, patients with a recent central catheter in the jugular vein may develop suppurative jugular thrombophlebitis due to Staphylococcus aureus or other organisms.

Metastatic sites of infection including septic emboli to the lungs and brain or kidney abscesses are commonly identified.

Codes

ICD10CM:
I80.8 – Phlebitis and thrombophlebitis of other sites

SNOMEDCT:
240444009 – Fusobacterial necrotizing tonsillitis

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Other bacterial head and neck infections – CT scan of the head and neck with contrast or ultrasound should be obtained.
  • Pneumonia – The pulmonary septic emboli in Lemierre syndrome may be confused for bacterial pneumonia.
  • Endocarditis – May also be associated with pulmonary septic emboli.

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 05/20/2016
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Emergency: requires immediate attention
Lemierre syndrome
Print 1 Images
Lemierre syndrome : Cervical lymphadenopathy, Fever, Neck pain, Rigors, Tachycardia, Diaphoresis, Pharyngitis
Copyright © 2019 VisualDx®. All rights reserved.