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Lemierre's syndrome; jugular vein suppurative thrombophlebitis
constellation of signs & symptoms that arise in the weeks following pharyngitis
Etiology:
- Fusobacterium necrophorum superinfection of primary pharyngitis (EBV mononucleosis) [1]
Epidemiology:
- median age at onset is 19 years
Pathology:
- anaerobic tonsillitis
- thrombophlebitis of the internal jugular vein
- parotitis, parotid abscess
Clinical manifestations:
- occurs weeks following pharyngitis
- fever
- pharyngitis
- unilateral facial edema
- trismus
- double vision
Radiology:
- CT of neck with IV contrast (visualizes intracranial vasculature)
- magnetic resonance imaging of the head & neck
- doppler ultrasound can be used
- cannot visualize beneath mandible & clavicle
- lower sensitivity than CT for detecting newly formed clots
Complications:
- orbital abscess
- intracranial complications in 6% of patients
Management:
- vancomycin, clindamycin & meropenem
- symptoms may progress despite adequate antibiotic therapy
General
syndrome
bacterial infection
thrombophlebitis (includes superficial venous thrombosis)
References
- Olson KR et al
Case 36-2014 - An 18-Year-Old Woman with Fever, Pharyngitis,
and Double Vision.
N Engl J Med 2014; 371:2018-2027. November 20, 2014
PMID: 25409375
http://www.nejm.org/doi/full/10.1056/NEJMcpc1310001
- Lee WS, Jean SS, Chen FL, Hsieh SM, Hsueh PR.
Lemierre's syndrome: A forgotten and re-emerging infection.
J Microbiol Immunol Infect. 2020 Aug;53(4):513-517.
PMID: 32303484 Free article. Review.