Lemierre syndrome involving external jugular vein

Abstract

Case A 74‐year‐old woman with a week‐long history of cold symptoms was diagnosed with Lemierre syndrome that involved her left external jugular vein. Outcome The patient was successfully treated with 4 weeks of antibiotics and anticoagulant treatment. Typical cases of Lemierre syndrome involve only the internal jugular vein. The external jugular vein is anatomically distant from the pharyngolaryngeal space and usually does not receive blood or lymphatic flow from there. Thus, Lemierre syndrome ordinarily does not involve the external jugular vein and clinical characteristics of external jugular vein‐involving Lemierre syndrome have not been uncovered, mainly due to its rarity. Based on our review, it would not much differ from those of typical cases. Conclusion Considering the potential severity and mortality, more attention should be paid to this potentially fatal disease that may demonstrate atypical manifestation, as shown in this case. Accumulation of cases would be needed for further understanding.

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

“…Lemierre’s syndrome is thought to involve the IJV in most cases as the venous drainage of the oropharyngeal mucosa and tonsils is typically to the IJV. 15 In some patients, venous connections between the oropharyngeal veins and the EJV have been observed; 16 if present, these allow direct propagation of thrombophlebitis into the EJV in the presence of oropharyngeal infection. These variant venous connections are thought to be responsible for the five previously published cases of isolated EJV involvement.…”

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

Idiopathic Bilateral External Jugular Vein Thrombosis

“…Most of the reported cases of external jugular vein thrombosis were treated with anticoagulants, which led to complete resolution of the symptoms. The cases caused by Lemierre’s syndrome used the combination of antibiotics and anticoagulants, although the use of anticoagulants in Lemierre’s is still controversial [ 6 , 13 – 15 ]. Gale et al and Colomina et al both used anticoagulants [ 9 , 11 ].…”

“…Regarding the recurrence of external jugular vein thrombosis, there is no published report of any signs of recurrence of thrombosis in external jugular veins [ 6 , 9 , 11 , 13 – 15 ]. Moreover, the study by Gbaguidi et al also reported no recurrence of thrombosis in internal jugular veins in the 29 patients after 12-month follow-up [ 7 ].…”

“…Aneurysm of the external jugular vein can also predispose to thrombus formation [ 12 ]. Lemierre’s syndrome has been associated with external jugular vein thrombosis in several case reports [ 6 , 13 – 15 ].…”