Clinical

- often presents with fever / rigors, localized neck / throat pain, tenderness / swelling overlying jugular vein / jaw

- frequently preceded by pharyngitis, however can also be preceded by dental infections or infectious mononucleosis

- average interval between preceding pharyngitis and jugular vein thrombophlebitis is approx. 1 week

- septic emboli to lung common

- most common pathogen is fusobacterium necrophorum

Evaluation

- CTA of neck is the most useful radiographic tool to evaluated for jugular vein suppurative thrombophlebitis

- blood cultures often positive

Treatment

- intravenous antibiotics: beta lactamase resistant beta lactam (unasyn or zosyn or carbapenem)

- consider surgical intervention in setting of ongoing sepsis or for patients who have not responded to antibiotics

- anticoagulation controversial

Final Pearls: Extremely rare disease but should be suspected in patients with persistent pharyngitis, septic pulmonary emboli, and persistent fevers despite antibiotics

REFERENCES

Johannesen, Katrine M., and Uffe Bodtger. "Lemierre’s syndrome: current perspectives on diagnosis and management." Infection and drug resistance 9 (2016): 221.

Karkos, Peter D., et al. "Lemierre's syndrome: a systematic review." The Laryngoscope 119.8 (2009): 1552-1559.

Reicher, John, et al. "An unusual case of cavitating pulmonary nodules: Lemierre’s syndrome with isolated involvement of the external jugular vein." BJR case reports 4.xxxx (2018): 20170093.

Ridgway, James M., et al. "Lemierre syndrome: a pediatric case series and review of literature." American journal of otolaryngology 31.1 (2010): 38-45.

Riordan, T., and M. Wilson. "Lemierre’s syndrome: more than a historical curiosa." Postgraduate Medical Journal 80.944 (2004): 328-334.