Lemierre syndrome

Lemierre syndrome, also known as postanginal sepsis or necrobacillosis, is a rare but potentially life-threatening infectious condition that typically begins with an oropharyngeal infection (most commonly a sore throat or peritonsillar abscess) and progresses to septic thrombophlebitis of the internal jugular vein. The condition is most often caused by the anaerobic bacterium Fusobacterium necrophorum, although other organisms may occasionally be implicated. It predominantly affects previously healthy adolescents and young adults. The disease follows a characteristic clinical course: an initial pharyngeal infection spreads to the lateral pharyngeal space and subsequently involves the internal jugular vein, leading to thrombosis and bacteremia. From the infected thrombus, septic emboli disseminate to distant sites, most commonly the lungs (causing pulmonary abscesses, cavitary lesions, or empyema), but also potentially affecting the joints, bones, liver, kidneys, soft tissues, and central nervous system. Key symptoms include persistent high fever, rigors, neck pain and swelling (often unilateral), respiratory symptoms such as cough and pleuritic chest pain, and signs of sepsis. Patients may appear disproportionately ill relative to the initial throat infection. Treatment of Lemierre syndrome requires prolonged courses of intravenous antibiotics effective against anaerobic organisms, typically including beta-lactam/beta-lactamase inhibitor combinations, carbapenems, or metronidazole. The role of anticoagulation therapy remains debated and is decided on a case-by-case basis. Surgical drainage of abscesses or, rarely, ligation of the internal jugular vein may be necessary. With appropriate antibiotic therapy, the prognosis has improved significantly compared to the pre-antibiotic era, though mortality rates remain estimated at approximately 5-18%. Early recognition is critical, as delayed diagnosis can lead to severe complications and death.

Common questions about Lemierre syndrome