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Lemierre's syndrome

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.

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