Introduction: Among unusual neck swellings diagnosed in our Neck Lump Clinics, Lemierre’s Syndrome or anaerobic postanginal sepsis was the least expected. Lemierre’s affects young immunocompetent adults. 3 phases of this syndrome are pharyngitis, thrombophlebitis of the internal jugular vein with neck swelling and distant septic metastases of thromboemboli which lead to multi-organ failure. Lemierre’s syndrome has a significant mortality rate (6–15%) because it can progress aggressively if not diagnosed and treated promptly.
Case report: A healthy 23-year-old Caucasian female was admitted with a two-day history of a red, painful and swollen left wrist as well as a ten-day history of fevers, rigors, shortness of breath and myalgia. Septic arthritis and pneumonia were suspected. Within 48 h, extensive left cervical swelling developed. Ultrasound and CT of her neck revealed peri-tonsillar abscess and thrombosed segment of internal jugular vein. Lemierre’s Syndrome was diagnosed and she was treated with a 6-week course of intravenous antibiotics, with full recovery.
Discussion: Mainstay of treatment is supportive measures, intravenous antibiotics and drainage of neck abscesses. Ligation and excision of the IJV is indicated for intraluminal collection. 3–6 weeks of intravenous antibiotic therapy is advocated until the patient is afebrile and anticoagulation for any propagation of IJV thrombosis towards the cavernous sinus.
Conclusion: The diagnosis of Lemierre’s syndrome is confirmed by unique clinical pictures, radiographical evidence of IJV thrombosis or culture of Fusobacterium species.
Lemierre’s syndrome should serve as a reminder of the consequences of failure to treat bacterial pharyngitis with appropriate antibiotics.
Conflict of interest: None declared.