Title : Lemierres syndrome following streptococcus anginosus pharyngitis: An unusual case of a forgotten disease
Abstract:
Introduction: Lemierre's syndrome (LS) is a rare complication of oropharyngeal infection characterized by septic thrombophlebitis in the Internal Jugular Vein. Despite this being a common occurrence before the era of antibiotics, with beta-lactam drug usage, this pathology has been a rare occurrence since the mid-1900s, especially in immunocompetent patients. While Fusobacterium necrophorum is the most common pathogen, other atypical microorganisms can also cause the syndrome. Progression of the acute infection further from the oropharynx leads to septic thrombus formation in internal jugular veins. This usually presents as unilateral neck swelling and tenderness. This gets further complicated as septic embolus can disseminate to other organs, most commonly being lungs resulting in end-organ damage.
Case Presentation: This case report presents a 42-year-old male with no significant medical history who developed Lemierre's syndrome following an atypical infection of Streptococcus anginosus pharyngitis. The patient initially presented with a sore throat, fever, neck pain, and swelling, which did not improve with standard antibiotics. The patient kept on worsening with increasing inflammatory markers and ongoing pyrexia. After one week of initial presentation, the patient developed pain and swelling in the neck. At this stage, imaging by CT scan of the neck revealed thrombosis of the internal jugular vein, a hallmark of LS. Blood cultures identified Streptococcus anginosus as the causative organism. CT scan of the chest revealed multiple septic emboli in both lungs. The patient was started on antibiotics and anticoagulation therapy, leading to significant improvement, and he was discharged with a follow-up arranged by the multidisciplinary team.
CT neck before anticoagulation: CT neck shows a thrombus within the left internal jugular vein measuring 2.6 x 2.6 x 8.2 cm (white arrow).
Discussion: This case emphasizes the importance of considering Lemierre's syndrome with high clinical suspicion in patients with persistent pharyngitis or unexplained neck pain and swelling. Early diagnosis and prompt intervention are crucial to avoid severe complications such as septic embolism and metastatic infections. While Fusobacterium necrophorum is typically associated with LS, this case demonstrates that other pathogens, such as Streptococcus anginosus, should also be considered. The patient’s favorable outcome underscores the importance of timely treatment with appropriate antibiotics and anticoagulation. This case also highlights the need for larger population studies to ensure evidence-based guidelines for the treatment of Lemierre’s syndrome are established. Further, it demonstrates how a multidisciplinary team approach and appropriate follow-up helped in the successful treatment of this rare yet serious condition.
Conclusion: In conclusion, clinicians should maintain a high suspicion of Lemierre’s syndrome in patients with refractory pharyngitis or signs of internal jugular vein thrombosis, regardless of the pathogen. Early diagnosis and intervention are essential to prevent life-threatening complications and ensure complete recovery. This case serves as a reminder to remain vigilant for this often-overlooked condition. References:
