Journal
CUREUS JOURNAL OF MEDICAL SCIENCE
Volume 14, Issue 3, Pages -Publisher
CUREUS INC
DOI: 10.7759/cureus.23420
Keywords
high mortality; young population; facial vein thrombosis; internal jugular vein thrombophlebitis; lemierre's syndrome
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Lemierre's syndrome is a rare disease that often occurs in young, healthy individuals, but its symptoms are not always typical. This article presents a case in which the diagnosis of Lemierre's syndrome was initially delayed due to the absence of internal jugular vein involvement, but was ultimately confirmed through blood culture identification.
Lemierre's syndrome is a rare disease that generally occurs in young, healthy individuals, where an index of suspicion for something so serious is often low. There is no standardized definition of Lemierre's syndrome, which has led to a dilemma if Lemierre's can be diagnosed without internal jugular vein (IJV) thrombophlebitis. We highlight a complex case of Lemierre's syndrome that deviates from the classical presentation of the disease. A 31-year-old male presented to the hospital with throat swelling and difficulty swallowing. He was in severe sepsis with end-organ damage. The patient developed severe pneumonia with pleural/pericardial effusions and bilateral nodular necrosed lesions during hospitalization. A facial vein thrombus was diagnosed, but the absence of internal jugular vein involvement initially delayed Lemierre's diagnosis. However, blood culture speciation revealed Fusobacterium necrophorum, which supported the suspected diagnosis. Persistent fevers and leukocytosis complicated the hospital course despite appropriate antibiotic coverage. The patient ultimately required bilateral thoracotomy and a pericardial window. He made a full recovery.
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