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Lemierre syndrome (septic thrombosis of the jugular vein)
Etiology:
- Streptococci
- beta-lactamase producing organisms
- anaerobes
- Fusobacterium
- Fusobacterium necrophorum
Pathology:
- septic thrombosis of the internal jugular vein
- metastatic pulmonary infections [1]
Clinical manifestations:
- pharyngitis
- fever
- unlateral neck tenderness
Laboratory:
- complete blood count
- leukocytosis, neutrophila. left shift
- routine testring for Fusobacterium necrophorum not recommended [1]
Radiology:
- chest X-ray may show multiple densities consistent with septic emboli
- CT of the neck with contrast confirms diagnosis
Management:
- intravenous antibiotics
- coverage should include
- Streptococci
- anaerobes (Fusobacterium)
- beta-lactamase producing organisms
- piperacillin tazobactam, or ticarcillin clavulate
- ampicillin sulbactam for Fusobacterium [1]
- carbapenem
Related
jugular vein
General
syndrome
thromboembolism
sepsis
References
- Medical Knowledge Self Assessment Program (MKSAP) 16
American College of Physicians, Philadelphia 2012
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022