Anticoagulation Contributes to Antimicrobial Treatment of Lemierre Syndrome: A Case Report

Abstract

Background: Lemierre syndrome (LS) is characterized by multisystemic infection beginning in the oropharynx, thrombophlebitis of the internal jugular vein and thrombotic extension to the periphery. It is difficult to establish an evidence-based guideline for management of the disease and the use of anticoagulation therapy remains controversial.Case presentation: A 61-year-old man suffered left neck swelling, odynophagia, and dyspnea. He underwent emergency surgery and received intravenous antimicrobial treatment. The primary infection was controlled on hospital day 5. However, he had a sudden increased WBC and decreased SpO on hospital day 6. Further thoracic CT angiography revealed an intraluminal filling defect in the pulmonary artery on hospital day 8. LS was diagnosed and then anticoagulation therapy was initiated. The WBC count maintained its peak value on hospital days 6-8 before anticoagulation therapy was initiated and decreased instantly after initiation.Conclusions: Our case supported the opinion that anticoagulation therapy contributed to the antiinflammatory effect achieved by the LS treatment.