Lemierre syndrome: A case report and literature review on atypical presentation.

RATIONALE

Lemierre syndrome (LS) is a rare but serious condition characterized by septic thrombophlebitis of the internal jugular vein (IJV), often secondary to infections in the head and neck region. It typically begins with an oropharyngeal infection, which may or may not be followed by distant septic emboli, most commonly affecting the lungs. The condition is usually caused by members of the normal oropharyngeal flora, with the anaerobic bacterium Fusobacterium necrophorum being the most prevalent pathogen. Timely diagnosis and antibiotic treatment are essential to prevent adverse outcomes. Clinical circumstances dictate the necessity for therapeutic anticoagulation and surgical intervention. LS can present atypically in terms of the antecedent condition, the etiological agent, the affected vein, and the distant manifestations. Despite the existence of a characteristic clinical presentation, many clinicians remain unaware of this rare condition, which can lead to delayed diagnosis and potentially fatal consequences.

PATIENT CONCERNS

A 55-year-old man presented with neck pain and swelling that had persisted for 1 week, following 2 weeks of blunt trauma to the head and neck, which resulted in several superficial abrasions due to his poorly managed epilepsy. Imaging studies revealed thrombosis in the left IJV, accompanied by an abscess that extended into the sternocleidomastoid muscle. Gram staining of the specimen obtained from the neck abscess confirmed the presence of Streptococcus bacteria.

DIAGNOSIS

The presence of a thrombus in the IJV following blunt trauma to the head and neck, along with a nearby soft tissue abscess, suggests a diagnosis of LS. However, this case is atypical due to the unusual preceding event of blunt trauma and the identification of a rare pathogen, specifically Streptococcus bacteria.

INTERVENTIONS

The patient received 2 weeks of intravenous antibiotic treatment with ceftriaxone and metronidazole, followed by 2 additional weeks of oral amoxicillin-clavulanate. Additionally, approximately 100 mL of foul-smelling pus was evacuated from the neck region.

OUTCOME

The patient has achieved a full recovery.

LESSONS

A strong clinical suspicion is essential for diagnosing this uncommon syndrome in patients with a history of head and neck conditions who experience IJV thrombosis or metastatic infections. This research aims to increase awareness of atypical presentations.