Lemierre’s Syndrome with Severe Thrombocytopenia without Disseminated Intravascular Coagulation: A Case Report and Literature Review

Abstract

Lemierre’s syndrome (LS) is an uncommon clinical entity characterized by a primary oropharyngeal infection with subsequent septic thrombophlebitis. Diagnosis is made with clinical or radiographic evidence of internal jugular vein (IJV) thrombosis, along with metastatic focus such as lungs or joints. Life threatening thrombocytopenia in Lemierre’s syndrome in the absence of disseminated intravascular coagulation (DIC) is rarely reported. We present a case of a 41-year-old woman with Lemierre’s syndrome caused by beta-hemolytic group C streptococci and fusobacterium species manifested as worsening pharyngitis, IJV thrombosis, and complicated by severe thrombocytopenia.

Severe thrombocytopenia and jaundice associated with Lemierre’s syndrome: A case report

“…The mechanisms of thrombocytopenia in Lemierre's syndrome are not fully understood. Chaudhary et al [8] stated that thrombocytopenia in Lemierre's syndrome was due to either sepsis-induced marrow suppression or presumed hemophagocytosis, which was not accurate. In the present case, bone marrow biopsy revealed active hyperplasia, indicating that bone marrow hematopoiesis was increased instead of suppressed; the increase in platelet consumption and destruction may be the main mechanism of thrombocytopenia in Lemierre's syndrome.…”

Atypical involvement of the thyro-linguo-facial vein in Lemierre syndrome

“…The thrombocytopaenia had already partially resolved at introduction; no complication was noted under anticoagulation. Thrombocytopaenia is often found in cases of LS12 probably caused by haemagglutination; disseminated intravascular coagulation is less common 2 13. Some cases of thrombocytopaenic purpura have been observed 14.…”