The classic presentation of Lemierre syndrome is that of a young (age 15–24 yr) patient with a recent oropharyngeal infection presenting with sepsis, unilateral neck pain from internal jugular thrombophlebitis, and clinical or radiologic evidence of septic emboli.
Throat pain is one of the most common chief complaints evaluated in many emergency departments across the country. While this is largely a minor medical complaint with no significant interventions required, there are a few life-threatening conditions that easily present as a throat pain. This article will address one of these life-threatening medical conditions: Infectious thrombophlebitis of the internal jugular vein commonly known as "Lemierre's Syndrome".
The disease was named for Dr. Andre Lemierre, who in 1936 described an infection seen almost exclusively in adolescents and young adults that begins with a sore throat and progresses to a painful and swollen neck. From there, it usually travels to the lungs and sometimes to the brain as well. Before antibiotics, the disease was usually fatal.
Lemierre’s syndrome (LS), once known as “the forgotten disease,” is a rare and potentially life-threatening condition that has had a gain in incidence over the last 30 years due to a variety of factors that could include changes in antibody prescription patterns, particularly in regard to the treatment of pharyngitis/tonsillitis.
Clinical suspicion should be high for this syndrome in patients with antecedent pharyngitits, persistent fevers, and septic pulmonary emboli.
Four cases of Lemierre syndrome are reported in which metastatic abscesses resulted from septic thrombosis of the internal jugular vein secondary to bacterial pharyngitis. While chest radiographic findings were nonspecific, results of computed tomography (CT) of the thorax in each case were highly suggestive of septic pulmonary emboli.
Lemierre's syndrome, also known as post-anginal septicemia or necrobacillosis, is characterized by bacteremia, internal jugular vein thrombophlebitis, and metastatic septic emboli secondary to acute pharyngeal infections. Modern physicians have “forgotten” this disease.
Lemierre’s syndrome should be suspected in young healthy patients with prolonged symptoms of pharyngitis followed by symptoms of septicemia or pneumonia, or an atypical lateral neck pain.
Why am I posting about this “zebra?” Well, Fusobacterium necrophorum infections may be more common in adolescents and young adults than previously suspected. There also seems to be a rise in the incidence of new diagnoses – and we are not sure why. Finally, it can make patients very sick, and it presents first like garden variety pharyngitis (think strep and mono). It should always be on your radar in the ill adolescent with a history of sore throat, fever and neck pain.
Lemierre’s syndrome is a severe illness caused by the anaerobic bacterium, Fusobacterium necrophorum which typically occurs in healthy teenagers and young adults. The infection originates in the throat and spreads via a septic thrombophlebitis of the tonsillar vein and internal jugular vein. The ensuing bacteraemia is complicated by septic emboli to a range of sites such as lung, joints, and bones. Although rare, there is evidence of a resurgence in the condition in recent years, possibly associated with reduced use of antibiotic therapy for sore throats. The typical clinical picture is characteristic but many clinicians are unaware of the condition and diagnosis is often delayed with potentially fatal consequences.
Most cases (73.4%) occurred in patients aged 16–25 years, but cases occasionally occurred in younger patients and older patients as well. Most patients were previously healthy individuals.
Historically the mortality of Lemierre’s was 90%, but even today it can be up to 15%, which is pretty significant. Part of that risk is that this is a tough diagnosis to make and usually requires a few visits to the healthcare system before a diagnosis is made. So we have to have a high index of suspicion!
Our main mission in this fight is to bring awareness of Lemierre’s Syndrome to the public. Especially to the Healthcare Community for faster screening, diagnoses & treatment of Lemierre’s Syndrome.
Lemierre syndrome is a rare and potentially life-threatening complication of bacterial infections that usually affects previously-healthy adolescents and young adults. It most commonly develops in association with a bacterial throat infection, but it may develop in association with an infection involving the ears, salivary glands (parotitis), sinuses, or teeth; or in association with an Epstein-Barr infection.
A ‘forgotten’ disease first described by Andre Lemierre in 1936, Lemierre syndrome has increased in incidence since the 1990s. Delayed diagnosis is common.