An unusual case of cavitating pulmonary nodules: Lemierre’s syndrome with isolated involvement of the external jugular vein

Reicher, John; Brooke, Sam; Arnold, Dominic; Counter, Paul; Abdelgalil, Alaa

doi:10.1259/bjrcr.20170093

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…In rare cases, the thrombus may propagate to the subclavian or cranial sinuses [ 7 ]. Septic emboli in the lungs may result in abscesses, sterile effusions empyema, and cavitation [ 2 , 15 ]. Indeed, most investigations for Lemierre syndrome begin with chest X-rays, possibly due to associated lung pathology from septic emboli [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Lemierre Syndrome With Streptococcus constellatus Bacteremia

Thomas,

Peterson,

Mazin

et al. 2023

Cureus

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Lemierre syndrome is characterized by thrombophlebitis of the internal jugular vein (IJV) secondary to bacterial pharyngitis or tonsillitis. Though antibiotic use has made this a rarer syndrome, it can nevertheless manifest in patients presenting with pharyngitis. Herein, we describe a 20-year-old male patient with no relevant medical history presenting with signs concerning for pneumonia and was ultimately diagnosed with Lemierre syndrome with Streptococcus constellatus bacteremia. Complications included IJV thrombus with presumed septic emboli to the lungs. The patient was discharged on ampicillin/sulbactam with plans to transition to amoxicillin/clavulanate.

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Section: Discussionmentioning

confidence: 99%

Lemierre Syndrome With Streptococcus constellatus Bacteremia

Thomas,

Peterson,

Mazin

et al. 2023

Cureus

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“…41 Several cases of EJV thrombosis cited in this study did use anticoagulation. 4,6,9,11,[13][14][15][16]18,[20][21][22][23]25,27,[29][30][31]33,34,41 However, the use of anticoagulants remains controversial due to potential risks such as hemorrhage, thrombocytopenia, and skin necrosis. These risks must be carefully weighed against the potential of a fatal thromboembolic event.…”

Section: Review Of the Literaturementioning

confidence: 99%

Isolated External Jugular Thrombophlebitis Secondary to Acute Pharyngitis: A Case Report and a Review of the Literature

Ezeh,

Tesema,

Hasnie

et al. 2024

Preprint

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Background External Jugular Thrombophlebitis (EJT) is a rare clinical phenomenon with few reports in the literature, especially in the pediatric population. This is a report of an unusual case of right-sided EJT in a pediatric patient secondary to acute pharyngitis with sinusitis most prominent on the left side. Case presentation: A 13-year-old presented to the emergency department with worsening upper respiratory infectious (URI) symptoms and facial swelling, cough, throat pain, and emesis. The patient had traveled to Switzerland and received amoxicillin for strep throat 6 weeks before this hospitalization. Physical examination revealed nasal purulence, allodynia over the right side of the face without overlying erythema, and oropharyngeal exudate. CT scan revealed left-sided predominate sinusitis and right external jugular vein thrombosis. Blood cultures confirmed the presence of group A streptococcus infection. Treatment included IV antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), IV steroids, and anticoagulation. Follow-up imaging demonstrated improvement in thrombosis, cellulitis, and sinus disease. The patient was discharged on antibiotics for 6 weeks and anticoagulation for 10 weeks. Follow-up imaging at 6 months revealed no EJT, and medications were discontinued. Conclusions EJT is a rare condition, and to our knowledge, no reports of EJT with sinusitis most pronounced on the contralateral side have been published. Physicians will benefit from noting clinical signs of EJT such as facial edema, headache, erythema, and palpable neck mass, especially if these symptoms occur with URI symptoms refractory to treatment. The use of anticoagulation is controversial for internal jugular vein thrombosis, and while no guidelines for EJT exist, anticoagulation is likely not necessary save for severe complications.

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Isolated external jugular thrombophlebitis secondary to acute pharyngitis: a case report and a review of the literature

Ezeh,

Tesema,

Hasnie

et al. 2024

Ital J Pediatr

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Background External Jugular Thrombophlebitis (EJT) is a rare clinical phenomenon with few reports in the literature, especially in the pediatric population. This is a report of an unusual case of right-sided EJT in a pediatric patient secondary to acute pharyngitis with sinusitis most prominent on the left side. Case presentation A 13-year-old presented to the emergency department with worsening upper respiratory infectious (URI) symptoms and facial swelling, cough, throat pain, and emesis. The patient had traveled to Switzerland and received amoxicillin for strep throat 6 weeks before this hospitalization. Physical examination revealed nasal purulence, allodynia over the right side of the face without overlying erythema, and oropharyngeal exudate. CT scan revealed left-sided predominate sinusitis and right external jugular vein thrombosis. Blood cultures confirmed the presence of group A streptococcus infection. Treatment included IV antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), IV steroids, and anticoagulation. Follow-up imaging demonstrated improvement in thrombosis, cellulitis, and sinus disease. The patient was discharged on antibiotics for 6 weeks and anticoagulation for 10 weeks. Follow-up imaging at 6 months revealed no EJT, and medications were discontinued. Conclusions EJT is a rare condition, and to our knowledge, no reports of EJT with sinusitis most pronounced on the contralateral side have been published. Physicians will benefit from noting clinical signs of EJT such as facial edema, headache, erythema, and palpable neck mass, especially if these symptoms occur with URI symptoms refractory to treatment. The use of anticoagulation is controversial for internal jugular vein thrombosis, and while no guidelines for EJT exist, anticoagulation is likely not necessary save for severe complications.

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An unusual case of cavitating pulmonary nodules: Lemierre’s syndrome with isolated involvement of the external jugular vein

Cited by 3 publications

References 22 publications

Lemierre Syndrome With Streptococcus constellatus Bacteremia

Lemierre Syndrome With Streptococcus constellatus Bacteremia

Isolated External Jugular Thrombophlebitis Secondary to Acute Pharyngitis: A Case Report and a Review of the Literature

Isolated external jugular thrombophlebitis secondary to acute pharyngitis: a case report and a review of the literature

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