Lemierre's Syndrome Variant with External Jugular Vein Thrombosis

Takiguchi, Junji; Sakamoto, Hirokazu; Inoue, N.

doi:10.2169/internalmedicine.56.8179

Cited by 8 publications

(7 citation statements)

References 1 publication

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“…Cases of atypical LS have been reported in adults, usually involving the external jugular vein, superior ophthalmic vein, and facial vein (7,(15)(16)(17)(18). Due to the rarity of this syndrome in the pediatric population, there are very few reports of atypical presentations.…”

Section: Discussionmentioning

confidence: 99%

Lemierre’s Syndrome with Facial Vein Thrombosis and Pulmonary Septic Emboli: A Case Report

Maia

Catarino²,

Freitas

et al. 2022

Arch Pediatr Infect Dis

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Introduction: Lemierre’s syndrome (LS) is a rare and serious condition that often affects school-aged children, adolescents, and healthy young adults. It is defined as an oropharyngeal infection with secondary septicemia, internal jugular vein thrombosis, and septic emboli. Rare cases of atypical LS in which thrombosis occurs in other locations have been reported. Case Presentation: We presented a case of an adolescent with fever, sore throat, and neck tenderness. Physical examination revealed acute pharyngitis and bilateral small cervical lymph nodes. Rapid antigen group A Streptococcus and viral serologic tests were negative. Complete hemogram and blood biochemical analysis showed leukocytosis and elevated serum C-reactive protein (CRP). Cervical computerized tomography (CT) scan revealed a heterogeneous right tonsil and small cervical lymph nodes. The chest radiograph was normal. After admission, the adolescent started complaining of dyspnea and thoracic pain and had a painful small cervical right mass. In the thoracic CT angiography (CTA), several pulmonary septic emboli were apparent throughout the pulmonary parenchyma. Cervical Doppler ultrasound showed right facial vein thrombophlebitis, later confirmed in a CTA. Thromboses in other locations, including the internal jugular vein, were excluded, as well as cervical abscesses. The patient was successfully treated with intravenous antibiotic therapy and anticoagulation. Discussion: To this date, no reports of LS presenting with isolated thrombosis of the facial vein have been described in pediatric patients. We highlighted the importance of early recognition of LS and its atypical variants. Pediatric international guidelines regarding its management and treatment would also greatly affect the outcome of these patients.

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Section: Discussionmentioning

confidence: 99%

Lemierre’s Syndrome with Facial Vein Thrombosis and Pulmonary Septic Emboli: A Case Report

Maia

Catarino²,

Freitas

et al. 2022

Arch Pediatr Infect Dis

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“…These variant venous connections are thought to be responsible for the five previously published cases of isolated EJV involvement. 15,17–20…”

Section: Outcome Follow-up and Discussionmentioning

confidence: 99%

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

et al. 2018

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A 65-year-old female presented with symptoms of tonsillitis and sepsis. Despite initial treatment with i.v. fluid and antibiotics, her condition deteriorated and she became hypoxaemic. CT pulmonary angiography showed no filling defects in the pulmonary arteries, but there were multiple cavitating lung nodules, initially thought to represent metastases. A subsequent contrast-enhanced CT of the neck and thorax demonstrated thrombosis of the left external jugular vein (EJV), leading to a revised diagnosis of Lemierre’s syndrome ( i.e. septic embolization from jugular thrombophlebitis). Noteworthy aspects of the case include the initial misdiagnosis of the cavitating lung nodules by the reporting radiologist and the isolated involvement of the EJV—Lemierre’s syndrome usually involves the internal jugular vein. The case highlights the importance of septic emboli in the differential diagnosis of cavitating lung nodules, and of assessment of the EJV as well as internal jugular vein in the context of oropharyngeal infection.

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“…26 In our case, as well as in the reviewed literature cases involving the EJV, the presenting symptoms were sore throat and fever. 3,4,7,8,12,14,18,21,27 These symptoms, usually indicate involvement of the peri(tonsillar) area. As for the side involving thrombophlebitis of the EJV, the left side was more often involved.…”

Section: Presenting Symptomsmentioning

confidence: 99%

“…16 Although this is mainly a young age group disease, in our review, LS was also found to be present in the 5 th to 8 th decades of life. 6,[17][18][19][20][21] Males are more commonly affected, 4 although for EJV thrombosis, there is an equal gender distribution. The annual incidence of LS is reported to be 3.6 per million persons/year.…”

Section: Age and Incidencementioning

confidence: 99%

Pediatric Patient with Lemierre Syndrome of the External Jugular Vein: Case Report and Literature Review

Schwarz

Habashi

Rosenfeld-Yehoshua

et al. 2021

Int Arch Otorhinolaryngol

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Introduction Lemierre syndrome (LS) involving the external jugular vein (EJV) is rare, and only a few cases have been reported in the literature. Objectives To report a case of LS involving the external jugular vein as well as to make a review of the literature regarding both diagnosis and management strategies. Data Synthesis We describe a case of LS involving the EJV and review the literature of previously published articles to search for additional cases. A PubMed, Embase, Scopus, and Web of science-based search was performed to determine the scope of coverage in well-reported articles in English. Twenty-one papers were retrieved and documented for age, incidence, pathogen, presenting symptoms, imaging, treatment, and outcome, which were noted for each of these cases. In our literature review of 21 papers, there were 16 patients (61%) in their 2nd and 3rd decades of life. Lemierre syndrome was shown to affect females and males equally. The presenting symptoms were a sore throat and fever. Treatment requires intravenous antibiotics, and there is no consensus regarding treatment with anticoagulation. Conclusions The present case report and review of the literature emphasize the importance of history taking as well as physical examination in what seems to be a case of simple tonsillitis.

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Lemierre's Syndrome Variant with External Jugular Vein Thrombosis

Cited by 8 publications

References 1 publication

Lemierre’s Syndrome with Facial Vein Thrombosis and Pulmonary Septic Emboli: A Case Report

Lemierre’s Syndrome with Facial Vein Thrombosis and Pulmonary Septic Emboli: A Case Report

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

Pediatric Patient with Lemierre Syndrome of the External Jugular Vein: Case Report and Literature Review

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