Multiple Cranial Nerve Palsies in a Pediatric Case of Lemierre’s Syndrome due to Streptococcus viridans

Background. Lemierre’s syndrome is a rare condition of internal jugular vein thrombosis following oropharyngeal infection. While it usually results from Fusobacterium necrophorum infection, atypical cases associated with other pathogens have been reported. Objective. To describe a unique case of pediatric Lemierre’s syndrome with Streptococcus viridans infection resulting in cavernous sinus thrombosis and oculomotor, trochlear, and abducens nerve palsies. Case Report. A 14-year-old female initially presented after six days of fever, myalgias, and sore throat and was admitted for hyperbilirubinemia and acute kidney injury. She developed a fixed, dilated pupil with complete ophthalmoplegia, ptosis, and severe pain. Imaging revealed retromandibular space abscess, external and internal jugular vein thrombosis, cavernous sinus thrombosis, internal carotid artery stenosis, pulmonary embolism, and bilateral pneumonia. She was diagnosed with Lemierre’s syndrome with cultures positive for Streptococcus viridans and treated with a combination of antibiotics and anticoagulation. Conclusion and Relevance. Both antibiotics and anticoagulation were effective management for this Lemierre’s syndrome patient with cavernous sinus thrombosis. Early diagnosis and treatment of Lemierre’s syndrome is essential. A multidisciplinary treatment team is beneficial for managing the sequelae of this condition.

Lemierre's Syndrome: A Case of a Large Inflammatory Neck Mass with Internal Jugular Vein Thrombosis and Literature Review of Its Surgical Intervention

Background: Lemierre's syndrome is a fatal and rare disease that is typically characterized by oropharyngeal infection and internal jugular vein thrombosis. Timely application of appropriate antibiotics is the standard treatment. However, when conservative medical treatment fails to have effect, surgical intervention may be the only effective option for controlling the source of infection. Case presentation: The authors report a case of Lemierre's syndrome with a large inflammatory neck mass involving left internal jugular vein thrombosis that was cured by surgical treatment. In addition, a literature review was carried out through PubMed using the terms “Lemierre’s syndrome/disease and review, meta-analysis or retrospective study” and “Lemierre’s syndrome/disease and internal jugular vein”. This search yielded 6 articles that recorded the surgical rate in detail. Conclusion: The purpose of this review was to summarize the conditions under which surgical treatment are conducted. Additionally, this is the first report of such a large inflammatory neck mass that was completely cured by surgical resection and internal jugular vein ligation. The authors further offer several conclusions regarding surgical intervention in Lemierre’s syndrome.

Metastatic carcinoma of the lung presenting as jugular venous thrombosis: a valuable clinical lesson

Thromboses of the upper extremity and neck are rare and not as commonly seen as lower extremity deep vein thrombosis (DVT). Internal jugular vein thrombosis (IJVT) is a serious condition with a potentially fatal outcome. Jugular vein thrombosis refers to the formation of intraluminal thrombi anywhere from the intracranial part of the jugular vein to the junction between the internal jugular vein (IJV) and subclavian vein. The relationship between malignancy and thromboembolic disorders has been well established, as Trousseau first described it in 1865. Tumor cells are known to promote hypercoagulability by expressing tissue factors that activate clotting cascades and procoagulants while promoting interactions between the tumor cells, platelets, and endothelial cells via different cytokines, tumor antigens, and their immune complexes. We are reporting our encounter with a patient who presented with extensive left internal jugular vein thrombosis as the first presenting sign of primary lung malignancy.

Internal Jugular Vein Thrombosis: Etiology, Symptomatology, Diagnosis and Current Treatment

(1) Background: internal jugular vein thrombosis (IJVthr) is a potentially life-threating disease but no comprehensive reviews on etiology, symptomatology, diagnosis and current treatment guidelines are yet available; (2) Methods: we prospectively developed a protocol that defined objectives, search strategy for study identification, criteria for study selection, data extraction, study outcomes, and statistical methodology, according to the PRISMA standard. We performed a computerized search of English-language publications listed in the various electronic databases. We also retrieved relevant reports from other sources, especially by the means of hand search in the Glauco Bassi Library of the University of Ferrara; (3) Results: using the predefined search strategy, we retrieved and screened 1490 titles. Data from randomized control trials were few and limited to the central vein catheterization and to the IJVthr anticoagulation treatment. Systematic reviews were found just for Lemierre syndrome, the risk of pulmonary embolism, and the IJVthr following catheterization. The majority of the information required in our pre-defined objectives comes from perspectives observational studies and case reports. The methodological quality of the included studies was from moderate to good. After title and abstract evaluation, 1251 papers were excluded, leaving 239 manuscripts available. Finally, just 123 studies were eligible for inclusion. We found out the description of 30 different signs, symptoms, and blood biomarkers related to this condition, as well as 24 different reported causes of IJVthr. (4) Conclusions: IJVthr is often an underestimated clinical problem despite being one of the major sources of pulmonary embolism as well as a potential cause of stroke in the case of the upward propagation of the thrombus. More common symptoms are neck pain and headache, whereas swelling, erythema and the palpable cord sign beneath the sternocleidomastoid muscle, frequently associated with fever, are the most reported clinical signs. An ultrasound of the neck, even limited to the simple and rapid assessment of the compression maneuver, is a quick, economic, cost-effective, noninvasive tool. High quality studies are currently lacking.

Unprovoked internal jugular vein thrombosis: a case report and literature review

Background Managing thrombosis in rare sites is challenging. Existing studies and guidelines provide detailed explanations on how to overcome lower-limb thromboses and pulmonary embolisms, but few studies have examined thrombosis in rare sites. Lack of data makes clinical practice heterogeneous. Recommendations for diagnosing, treating, and following-up internal jugular vein thrombosis are not clearly defined and mostly based on adapted guidelines for lower-limb thrombosis. Case presentation A 52-year-old Caucasian woman came to the Emergency Department with chest, neck, and left arm pain. Computed tomography imagery showed a left internal jugular vein thrombosis. An extensive workup revealed a heterozygous factor V Leiden gene. Therapy was initiated with intravenous unfractionated heparin, then switched to oral acenocoumarol, which resolved the symptoms. Based on this case presentation and a literature review, we summarize the causes, treatment options, and prognosis of unprovoked internal jugular vein thrombosis. Conclusions Managing internal jugular vein thrombosis lacks scientific data from large randomized clinical trials, partly because such thromboses are rare. Our literature review suggested that clinical treatments for internal jugular vein thrombosis often followed recommendations for treating lower-limb thrombosis. Future specific studies are required to guide clinicians on the modalities of diagnosis, screening for thrombophilia or oncologic disease, treatment duration, and follow-up.