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.
I80.8 – Phlebitis and thrombophlebitis of other sites
240444009 – Fusobacterial necrotizing tonsillitis
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 – Right-sided endocarditis may also be associated with pulmonary septic emboli.
- Epstein-Barr virus