Lemierre syndrome

Background

• Suppurative thrombophlebitis involving the jugular vein following acute pharyngitis, classically secondary to Fusobacterium necrophorum

Microbiology

• Fusobacterium necrophorum, the most common cause
• Other oral flora, including Fusobacterium species, Staphylococcus aureus, and Streptococcus pyogenes

Clinical Manifestations

• Acute pharyngitis that becomes severe
• Neck pain
• Fever
• May have septic emboli, including to lung

Diagnosis

• CT with contrast demonstrating internal jugular thrombosis
• Blood cultures positive to causative organism

Management

• Piperacillin-tazobactam or ampicillin-sulbactam
• Unclear if need for anticoagulation