A case of Lemierre-like Syndrome: internal jugular vein thrombosis secondary to Staphylococcus aureus sternoclavicular joint septic arthritis

Abstract Lemierre syndrome is the internal jugular vein (IJV) suppurative thrombophlebitis, usually secondary to oropharyngeal infection. Staphylococcus aureus is an emerging responsible pathogen. We report a unique case of IJV thrombosis secondary to methicillin-susceptible S. aureus sternoclavicular joint septic arthritis. We review the existing literature on Lemierre syndrome: its various manifestations, causative pathogens, treatment and management.

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Lemierre Syndrome in a Patient With Splenectomy Secondary to Pyruvate Kinase Deficiency, Complicated by Heparin Resistance

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/23247096211040635 ◽

2021 ◽

Vol 9 ◽

pp. 232470962110406

Author(s):

Kiley Clark ◽

Morgan Sly ◽

Pearl Chan ◽

Hobart Lai ◽

Hadi Ali ◽

...

Keyword(s):

Internal Jugular Vein ◽

Jugular Vein ◽

Transverse Sinus ◽

Jugular Vein Thrombosis ◽

Lemierre Syndrome ◽

Jugular Veins ◽

Vein Thrombosis ◽

Heparin Resistance ◽

Mandibular Molar ◽

Oropharyngeal Infection

Lemierre syndrome was first documented in the literature in 1936, and is defined as septic thrombophlebitis of the internal jugular vein. It is typically a result of oropharyngeal infection causing local soft tissue inflammation, which spreads to vasculature, and promotes formation of septic thrombi within the lumen, persistent bacteremia, and septic emboli. We present the case of a 24-year-old incarcerated man, who presented with leukocytosis and a right-sided tender, swollen neck after undergoing left mandibular molar extraction for an infected tooth. Computed tomography revealed a persistent thrombus in the transverse and sigmoid sinuses bilaterally, extending downwards, into the upper jugular veins. He was started on empiric intravenous vancomycin, zosyn, and heparin, but subsequently demonstrated heparin resistance, and was thus anticoagulated with a lovenox bridge to warfarin. Throughout his hospital course, hemocultures demonstrated no growth, so antibiotic treatment was deescalated to oral metronidazole and ceftriaxone. On discharge, the patient was transitioned to oral amoxicillin and metronidazole for an additional 4 weeks with continuation of anticoagulation with warfarin for a total of 3 to 6 months. This case report details a unique presentation of Lemierre syndrome with bilateral transverse sinus, sigmoid sinus, and internal jugular vein thrombosis that was presumably secondary to an odontogenic infectious focus.

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Bilateral Internal Jugular Vein Thrombosis: An Unusual Presentation of Lemierre Syndrome

Otolaryngology - Open Journal ◽

10.17140/otloj-2-115 ◽

2016 ◽

Vol 2 (2) ◽

pp. 70-72

Author(s):

Arpit Saxena ◽

◽

A V Ramesh ◽

Poonam Raj Mehra ◽

E. Nikhilesh ◽

...

Keyword(s):

Internal Jugular Vein ◽

Jugular Vein ◽

Unusual Presentation ◽

Jugular Vein Thrombosis ◽

Lemierre Syndrome ◽

Vein Thrombosis ◽

Internal Jugular Vein Thrombosis

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Lemierre Syndrome: Two Preschool Children with Cerebral Infarcts

Clinical medicine Pediatrics ◽

10.4137/cmped.s879 ◽

2008 ◽

Vol 1 ◽

pp. CMPed.S879

Author(s):

Miriam Santschi ◽

Michèle David ◽

Laurent Garel ◽

Michel Vanasse ◽

France Gauvin

Keyword(s):

Internal Jugular Vein ◽

Jugular Vein ◽

Fusobacterium Necrophorum ◽

Left Internal Jugular Vein ◽

Cerebral Infarcts ◽

Jugular Vein Thrombosis ◽

Lemierre Syndrome ◽

Vein Thrombosis ◽

First Case ◽

One Year

We report two children who developed hemiparesis secondary to cerebral infarcts complicating Lemierre syndrome. The first case is a one-year-old patient who presented a left internal jugular vein thrombosis and a left carotid compression due to retropharyngeal cellulitis. The second case is a five-year-old girl who presented a left internal jugular vein and a right carotid artery thrombosis associated with an oropharyngeal cellulitis. Etiologic agents involved were Staphylococus aureus in the first case and Fusobacterium necrophorum in the second case. These cases call for vigilance among physicians for this rare syndrome, its unusual presentation and its associated severe complications.

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Internal Jugular Vein Thrombosis, Lemierre's Syndrome; Oropharyngeal Infection with Antibiotic and Anticoagulation Therapy

Angiology ◽

10.1177/000331970005100212 ◽

2000 ◽

Vol 51 (2) ◽

pp. 173-177 ◽

Cited By ~ 31

Author(s):

Shin Nakamura ◽

Seizo Sadoshima ◽

Yasufumi Doi ◽

Maki Yoshioka ◽

Shigeru Yamashita ◽

...

Keyword(s):

Internal Jugular Vein ◽

Jugular Vein ◽

Anticoagulation Therapy ◽

Lemierre’S Syndrome ◽

Jugular Vein Thrombosis ◽

Vein Thrombosis ◽

Oropharyngeal Infection ◽

Internal Jugular Vein Thrombosis ◽

Lemierre's Syndrome

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Bilateral Lemierre's Syndrome: A Case Report and Literature Review

Ear Nose & Throat Journal ◽

10.1177/014556130208100412 ◽

2002 ◽

Vol 81 (4) ◽

pp. 234-252 ◽

Cited By ~ 37

Author(s):

Brian A. Moore ◽

Catherine Dekle ◽

Jay Werkhaven

Keyword(s):

Internal Jugular Vein ◽

Jugular Vein ◽

Fusobacterium Necrophorum ◽

Lemierre’S Syndrome ◽

Jugular Vein Thrombosis ◽

Jugular Veins ◽

Vein Thrombosis ◽

Warfarin Sodium ◽

Oropharyngeal Infection ◽

Lemierre's Syndrome

Lemierre's syndrome is characterized by thrombosis of the internal jugular vein that develops following an oropharyngeal infection. Sepsis and septic metastases frequently ensue and affect the lungs, the musculoskeletal system, and occasionally the liver. Most cases are caused by infection with Fusobacterium necrophorum. This infection responds to antibiotic therapy with beta-lactamase-resistant compounds that exert good anaerobic coverage. Anticoagulation and surgical intervention can be helpful in advanced cases. Fewer than 160 cases of classic Lemierre's syndrome have been described; approximately one-third of these reported cases have occurred since 1988. We describe a new case of Lemierre's syndrome that occurred in an otherwise healthy 27-year-old man. Thrombosis of both internal jugular veins extended through the subclavian system and into both upper extremities. The patient was treated with intravenous antibiotics and heparin during 14 days of hospitalization. He was discharged on oral clindamycin and warfarin sodium, and after 6 months he was able to return to full activity. To our knowledge, this is the first reported case of Lemierre's syndrome in which internal jugular vein thrombosis occurred bilaterally. By reporting this previously undescribed manifestation of Lemierre's syndrome, we hope to increase practitioner awareness of this disease entity.

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Internal Jugular Vein Thrombosis following Oropharyngeal Infection

Case Reports in Vascular Medicine ◽

10.1155/2015/538439 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Asli Bostanci ◽

Murat Turhan

Keyword(s):

Internal Jugular Vein ◽

Jugular Vein ◽

Rare Condition ◽

Jugular Vein Thrombosis ◽

Acute Tonsillitis ◽

Vein Thrombosis ◽

Venous Catheterization ◽

Oropharyngeal Infection ◽

Internal Jugular Vein Thrombosis ◽

Iv Drug Use

Internal jugular vein thrombosis (IJVT) is a rare condition which may lead to life-threatening complications such as sepsis and pulmonary embolism. Prolonged central venous catheterization, intravenous (IV) drug use, trauma, and radiotherapy are the most frequent causes of the IJVT. IJVT that develops after the oropharyngeal infection is a quite rare situation today. In this paper, a 37-year-old woman was presented; swelling occurred on her neck after acute tonsillitis and she was diagnosed with IJVT through Doppler ultrasonography and magnetic resonance imaging and managed without complications. Early diagnosis and conservative treatment with broad-spectrum IV antibiotics and anticoagulant agents have a critical importance for the prevention of fatal complications.

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