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.