Volume 6, Number 15;  August 4, 2006

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Unique Identifier [PMID]: 12441902

Authors: Chirinos JA. Lichtstein DM. Garcia J. Tamariz LJ.

Institution: Department of Medicine, University of Miami School of Medicine, FL, USA.

Title: The evolution of Lemierre syndrome: report of 2 cases and review of the literature. [Review] [92 refs]

Source: Medicine. 81(6):458-65, 2002 Nov.

Abstract: Lemierre syndrome (postanginal septicemia) is caused by an acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein and frequent metastatic infections. A high degree of clinical suspicion is necessary for diagnosis. Fusobacterium necrophorum is the usual etiologic agent. The disease progresses in several steps. The first stage is the primary infection, which is usually a pharyngitis (87.1% of cases). This is followed by local invasion of the lateral pharyngeal space and IJV septic thrombophlebitis (documented in 71.5% of cases), and finally, the occurrence of metastatic complications (present in 90% of cases at the time of diagnosis). A sore throat is the most common symptom during the primary infection (82.5% of cases). During invasion of the lateral pharyngeal space and IJV septic thrombophlebitis, a swollen and/or tender neck is the most common finding (52.2% of patients) and should be considered a red flag in patients with current or recent pharyngitis. The most common site of metastatic infection is the lungs (79.8% of cases). In contrast to the preantibiotic era, cavitating pneumonia and septic arthritis are now uncommon. Most patients (82.5%) had fever at some stage during the course of the disease. Gastrointestinal complaints such as abdominal pain, nausea, and vomiting were common (49.5% of cases). An elevated white blood cell count occurred in 75.2% of cases. Hyperbilirubinemia with slight elevation of liver enzyme levels occurred in one-third of patients, but frank jaundice was uncommon, in contrast to its high frequency reported in the preantibiotic era. We conclude that, most likely as a consequence of widespread antibiotic use for pharyngeal infections, the typical course of the disease has changed since Lemierre's original description. The typical triad in our series was: pharyngitis, a tender/swollen neck, and noncavitating pulmonary infiltrates. The previous classical description of severe sepsis with cavitating pneumonia and septic arthritis was not commonly seen in our review. Mortality was low in our series (6.4%), but significant morbidity occurred, which was likely preventable by early diagnosis and treatment. The pathophysiology, natural history, diagnostic methods for internal jugular vein thrombosis, and management are discussed. [References: 92]

Publication Type: Case Reports. Journal Article. Review.

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Unique Identifier [PMID]: 2646510

Authors: Sinave CP. Hardy GJ. Fardy PW.

Institution: Department of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.

Title: The Lemierre syndrome: suppurative thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection. [Review] [75 refs]

Source: Medicine. 68(2):85-94, 1989 Mar.

Abstract: We present 2 cases of the Lemierre syndrome (also called postanginal septicemia), along with 36 other cases from a review of recent literature. A review of the literature during the preantibiotic era is also included. This disease is caused by an acute oropharyngeal infection with secondary thrombophlebitis of the internal jugular vein complicated by multiple metastatic infection. The majority of cases are caused by anaerobic gram-negative organisms, most frequently Fusobacterium necrophorum. An enhanced computed tomographic scan of the neck is the technique of choice to demonstrate the thrombosis of the internal jugular vein. Prolonged intravenous administration of antimicrobial agents known to have a good antianaerobic coverage, along with drainage of purulent collections, will usually be successful in the overwhelming majority of patients. [References: 75]

Publication Type: Case Reports. Journal Article. Review.

Resident Report / Department of Medicine & Grady Branch Library

Emory University School of Medicine

2006 Edition

Participating Faculty:  Carlos Del Rio MD  / Joyce Doyle MD / Lorenzo Difrancesco MD / Joel Mermis MD / Maunank Shah MD

Contact: Karl Woodworth