Lemierre's syndrome; jugular vein suppurative thrombophlebitis

Introduction

constellation of signs & symptoms that arise in the weeks following pharyngitis

Etiology

• Fusobacterium necrophorum superinfection of primary pharyngitis (EBV mononucleosis)

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

More general terms

• syndrome
• bacterial infection
• thrombophlebitis (includes superficial venous thrombosis)