SFGH 8.12 AM report pearls: Lemierre’s disease

Lemierre’s syndrome (aka, Jugular vein thrombophlebitis):

  • Also known as: postanginal sepsis (like with Ludwig’s angina, the angina part is from the greek word ankhon meaning “strangling”, not related to chest pain)
  • Classic Lemierre’s syndrome is most commonly caused by fusobacterium necrophorum
  • primary infection usually associated with pharyngitis affecting the tonsils, rarely from tooth infection, mastoiditis, otitis media.  The time course is estimated as 1-3 weeks post primary infection.
  • in one study, 97% of patients with Lemierre’s syndrome had pulmonary emboli
  • treat with 4-6 weeks of antibiotics
  • limited data on use of anticoagulation: some experts advocate use when a thrombosis has potential for retrograde progression to the cavernous sinus or in extensive thromboses
  • New oral anticoagulants (NOACs) have a lower rate of intracranial bleeding than warfarin

Kuppalli et al.  Lemierre’s syndrome due to Fusobacterium necrophorum.  Lancet: infectious diseases. 2012. 12(10); 808-815.

Evernote link: http://www.evernote.com/l/AoN9YbVFQDlHlr3m7NstnPRIBb2tlh7di-U/

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