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, 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
- May step down to oral amoxicillin-clavulanic acid when clearly improving
- Duration 3 to 6 weeks total, for example 2 weeks IV and 2 weeks p.o.)
- Alternatives include penicillin G (if susceptible), clindamycin, carbapenems, and metronidazole (occasionally resistant)
- Resistant to macrolides
- Unclear if need for anticoagulation
