Necrobacillosis resulting in isolated carotid thrombosis and massive stroke: A unique Lemierre variant?

We describe a healthy, young adult male patient who developed isolated carotid artery thrombosis and occlusion following acute pharyngitis due to Fusobacterium necrophorum. We believe this is the first case of isolated occlusion of internal carotid artery (ICA) with F necrophorum without associated internal jugular vein (IJV) thrombosis. Lemierre's syndrome (IS) is characterized by a history of recent oropharyngeal infection in previously healthy individuals, clinical or radiological evidence of internal jugular vein thrombosis, and isolation of anaerobic pathogens, mainly F. necrophorum. We discuss literature on this rare, previously unreported, variant of IS. (C) 2009 Elsevier B.V. All rights reserved.