Lemierre syndrome (Updated – Aug 2014.)

Righini CA, Karkas A, Tourniaire R, et al. Lemierre syndrome: A study of 11 cases and literature review. Head Neck. 2014 Jul;36(7):1044-51.

“Background: Lemierre syndrome is a rare but serious illness that associates throat infection and thrombosis of the internal jugular vein (IJV) or one of its tributaries with subsequent distant septic emboli. The aim of our study is to review the pathogenesis, clinical presentation, and treatment of this disease. Methods: Patients with confirmed Lemierre syndrome were included in our retrospective monocentric study. All patients had bacteriologic analyses as well as radiologic imaging. Results: There were 11 patients in our study (1998-2012). Fusobacterium necrophorum was responsible for the infection in 45% of cases. Surgical drainage of pharyngeal, cervical or mediastinal abscesses was carried out in 8 cases. All patients received broad-spectrum antibiotics. 6 patients were admitted to the intensive care unit (ICU). One patient (9%) died. Conclusion: Treatment with broad-spectrum antibiotics is the primary choice of treatment of Lemierre syndrome. Surgery is indicated in case of abscess formation.”

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Cardenas-Garcia J, Narasimhan M, Koenig SJ. A teenager with fever and sore throat. Diagnosis: Lemierre syndrome. Chest. 2014 Apr;145(4):e10-3.

Lemierre syndrome is a rare but serious illness that associates oropharyngeal infection involving the palatine tonsils or peritonsillar tissue and thrombosis of the internal jugular vein (IJV). There is a 1- to 3-week time interval [1] during which distant septic pulmonary and systemic emboli occur. Lemierre syndrome commonly occurs in young adults and is mainly caused by Fusobacterium necrophorum, [2,3] an anaerobic gram-negative bacillus that is part of the normal oral flora. However, other organisms, including Bacteroides, Eikenella, Streptococcus,Peptostreptococcus, Porphyromonas, Prevotella, Proteus, methicillin-resistant Staphylococcus aureus, and methicillin-sensitive S aureus may also cause Lemierre syndrome. [4,5]

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Young BJ, Steele RW. A teenager with sore throat and neck pain. Clin Pediatr (Phila). 2011 Apr;50(4):355-6.

“Characteristically a disease of previously healthy adolescents and young adults, the initial presentation of Lemierre’s syndrome is sore throat or neck pain. The primary pharyngitis is most often caused by a bacterium of the Streptococcus species, leading to formation of peritonsillar cellulitis or an abscess. Within the abscess, anaerobic species flourish,  penetrating into the closely neighboring internal or less commonly, external jugular vein. Usually within 1 to 2 weeks of the initial infection, a septic thrombus forms within the jugular vein. Ensuing bacteremia may lead to spiking fever, lethargy, or shock. Infected emboli may also disseminate from the clot. These often seed into the lungs, leading to cough, shortness of breath, pleurisy, hemoptysis, and respiratory failure. Septic emboli may also settle within the joints, leading to arthralgia or disseminate to the liver, kidneys, spleen, or meninges.”

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Weeks DF, Katz DS, Saxon P, Kubal WS. Lemierre syndrome: report of five new cases and literature review. Emerg Radiol. 2010 Jul;17(4):323-8.

“It is especially noteworthy that nearly half of patients in one review had a normal physical examination [6]. Clinical findings in the oropharynx, when present, may be deceptively mild, consisting of localized hyperemia or swelling with little to suggest more extensive disease [8, 9]. Cervical lymphadenopathy and tenderness may be present. Embolic disease to the lungs is most common and is associated with cough, dyspnea, and pleuritic pain. Emboli to numerous other sites, including muscle, bone, brain, and liver have been described, although nonpulmonary manifestations of LS most often affect large joints [5].”

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Ridgway JM, Parikh DA, Wright R, et al. Lemierre syndrome: a pediatric case series and review of literature. Am J Otolaryngol. 2010 Jan-Feb;31(1):38-45.

“Lemierre syndrome is a rare disease of the head and neck often affecting adolescents and young adults. Classically, infection begins in the oropharynx with thrombosis of the tonsillar veins followed by involvement of the parapharyngeal space and the internal jugular vein. Septicemia and pulmonary lesions develop as infection spreads via septic emboli. Although a rare entity in modern times, Lemierre syndrome remains a disease of considerable morbidity and potential mortality.”

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More PubMed results on Lemierre syndrome.

Created 09/24/13, updated 08/12/14.

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