Lemierre's syndrome

Background

• Also known as "Lemierre's disease" and "postanginal shock including sepsis" and "human necrobacillosis"
• Is a form of thrombophlebitis
• Usually caused by Fusobacterium necrophorum, and occasionally by other members of the genus Fusobacterium (F. nucleatum, F. mortiferum and F. varium etc.) or MRSA
• Usually affects young, healthy adults, most often developing after Strep Pharyngitis causing Peritonsilar Abscess
  • Anerobic bacteria grow in the PTA and penetrate into the neighboring jugular vein causing thrombophlebitis and bacteremia and septic emboli and occassionally pneumonia and sepsis

Epidemiology

Very rare, incidence rate of 0.8 cases per million in the general population,

Diagnosis

• Persistent sore throat, fever, and general weakness
• 2 days - 2 weeks after initial symptoms:
  • extreme lethargy, spiked fevers, rigors, swollen cervical lymph nodes and a swollen, tender or painful neck
  • Often there is abdominal pain, diarrhea, nausea and vomiting during this phase.
  • May lead to:
    • Pneumonia
    • Septic Arthritis
    • Meningitis
    • Sepsis

Differential Diagnosis

• Q fever
• Tuberculosis
• Pneumonia

Workup

• CTA of neck
• Blood Cultures

Management

• Antibiotics
  • IV Antibiotics
• Drainage of abscess
• Consider ligation of the internal jugular vein where antibiotic can not penetrate.
• No evidence for or against anticoagulation

Disposition

• Admit
• When diagnosed, mortality is 4.6%