Makindo Medical Notes

Thrombophlebitis of the internal jugular vein and bacteremia caused by primarily anaerobic organisms, following a recent oropharyngeal infection with subsequent systemic septic foci

📖 About

• 🧑‍⚕️ First described in 1936 by Dr André Lemierre.
• ⚠️ Characterised by septic thrombophlebitis of the internal jugular vein after an oropharyngeal infection.
• 🎯 Typically affects young, previously healthy adults.
• 💥 Can lead to disseminated abscesses in lungs, liver, brain, muscle, skin, and pericardium.

🧬 Aetiology

• Local invasion of the lateral pharyngeal space.
• ➡️ Septic thrombophlebitis of the internal (± external) jugular vein.
• 🔑 Most commonly caused by Fusobacterium necrophorum (gram-negative anaerobe).
• May be polymicrobial with Streptococcus, Staphylococcus, Peptostreptococcus, Enterococcus, and occasionally Proteus.

🦠 Microbiology

• Fusobacterium necrophorum → also called necrobacillosis.
• Other contributors: Peptostreptococcus, Group B & C Streptococcus, Staphylococcus, Enterococcus, Proteus.

🩺 Clinical Features

• 🧑‍🦱 Usually young adults/children with prolonged sore throat or pharyngitis.
• 🤒 Fever, severe pharyngitis, dysphagia, odynophagia.
• 💥 Severe unilateral neck pain at jugular vein site.
• 🫁 Septicaemia with pulmonary abscesses/cavitation.
• 🧠 Focal neurology from brain abscesses.
• 🦠 Localised lymphadenopathy.
• 🧵 Evidence of jugular vein thrombosis (tender cord in neck).
• 👁️ Horner’s syndrome reported in rare cases.

🔎 Investigations

• 🧪 Bloods: FBC, U&E, LFTs, CRP → sepsis picture.
• 🧫 Blood cultures → anaerobic growth (often F. necrophorum).
• 📈 ECG: tachycardia with systemic illness.
• 🩻 CXR: multiple foci of consolidation, cavitation, effusions.
• 🖥️ CT neck with contrast: shows pharyngeal inflammation & jugular vein thrombosis.
• 🖲️ Doppler USS: internal/external jugular thrombosis.

💊 Management

• 🫁 Resuscitate: ABC, IV access, sepsis management.
• 💉 Broad-spectrum IV antibiotics → Metronidazole, clindamycin, or beta-lactam/β-lactamase inhibitor.
• ⏳ Prolonged antibiotic therapy required (weeks).
• 💊 Anticoagulation (LMWH) → consider if confirmed jugular thrombosis.
• 👂 ENT/anaesthetics involvement if airway compromise suspected.

💡 Exam tip: Think Lemierre’s syndrome in a young adult with recent pharyngitis, sepsis, and cavitating lung lesions. Classic culprit = Fusobacterium necrophorum.