Lemierre's syndrome

(Redirected from Lemierre's Disease)

Background

Epidemiology

  • Very rare, incidence rate of 0.8 cases per million in the general population[2]
  • When diagnosed, mortality is 4.6%[3]

Clinical Features

Example of an intracranial complication: paresis of the abducens nerve (demonstrated in the right eye when looking to the right).

Differential Diagnosis

Acute Sore Throat

Bacterial infections

Viral infections

Noninfectious

Other

Evaluation

POCUS shows IJ thrombus[5]
CT of the neck showing partial thrombosis of the right internal jugular vein (black arrow) and complete thrombosis of the right external jugular vein (white arrow).

Workup

Evaluation

Diagnostic criteria:

  • History of oropharynx pain within last 4 wks
  • Evidence of IJV thrombophlebitis/carotid sheath
  • Isolation of F. necrophorum from blood
  • Evidence of metastatic infection in another site (lungs)

Management

Disposition

  • Admit

See Also

Video

References

  1. "Lemierre syndrome" at Dorland's Medical Dictionary
  2. Sibai K, Sarasin F (2004). "Lemierre syndrome: a diagnosis to keep in mind". Revue médicale de la Suisse romande (in French) 124 (11): 693–5. PMID 15631168.
  3. Centor RM. "Expand the Pharyngitis Paradigm for Adolescents and Young Adults." Ann Intern Med. 2009;151(11):812-815. doi:10.7326/0003-4819-151-11-200912010-00011
  4. Melio, Frantz, and Laurel Berge. “Upper Respiratory Tract Infection.” In Rosen’s Emergency Medicine., 8th ed. Vol. 1, n.d.
  5. http://www.thepocusatlas.com/soft-tissue-vascular/
  6. Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ (November 2002). "The evolution of Lemierre syndrome: report of 2 cases and review of the literature". Medicine (Baltimore) (Lippincott Williams & Wilkins) 81 (6): 458–465. doi:10.1097/00005792-200211000-00006. PMID 12441902.
  7. Puymirat E, Biais M, Camou F, Lefèvre J, Guisset O, Gabinski C (March 2008). "A Lemierre's syndrome variant caused by Staphylococcus aureus". American journal of emergency medicine test (Elsevier) 26 (3): 380–387. doi:10.1016/j.ajem.2007.05.020. PMID 18358967.
  8. Hoehn KS. Lemierre’s syndrome: the controversy of anticoagulation. Pediatrics. 2005;6(5):1415–1416.