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Emergency: requires immediate attention
Lemierre syndrome
Other Resources UpToDate PubMed
Emergency: requires immediate attention

Lemierre syndrome

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 septic thrombophlebitis of the internal jugular vein usually caused by anaerobic bacteria following a bacterial pharyngitis. While Fusobacterium necrophorum, an anaerobic gram-negative rod that is a component of the normal oral flora in humans, is the most commonly associated pathogen, the infection can be polymicrobial.

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. Klebsiella pneumonia, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus (MRSA), F nucleatum, and beta-hemolytic streptococci have also been identified. In some cases, patients with a recent central catheter in the jugular vein may develop suppurative jugular thrombophlebitis due to S aureus or other organisms.

Codes

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

SNOMEDCT:
240444009 – Fusobacterial necrotizing tonsillitis

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Last Reviewed:11/17/2021
Last Updated:11/23/2021
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Emergency: requires immediate attention
Lemierre syndrome
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Lemierre syndrome : Cervical lymphadenopathy, Fever, Neck pain, Rigors, Tachycardia, Diaphoresis, Pharyngitis
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