Lemierre’s syndrome

25 Jun

What is it?

Bacteremia secondary to infected thrombosis that occurred as a result of peritonsilar abscess.

How does it occur?

usually occurs in young, healthy patients who have a Strep infection that progresses to peritonsilar abscess without proper treatment.

Within the abscess, anaerobic bacteria (most common Fusobacterium necrophorum) grow.

The bacteria eventually penetrate into the neighboring jugular vein and cause a thrombus to form.

The thrombus can subsequently cause smaller clots to be scattered in the blood stream, leading to, among other consequences, septic emboli into the lungs.

How do I treat it?

The most difficult step in treating the disease is recognizing that the patient has the infection since it is so rare.

So, always keep this diagnosis in the back of your mind with someone who has a good story for a PE and is septic appearing and/or had a recent or concurrent oropharyngeal infection.

Start the patient on antibioticsF. necrophorum is generally susceptible to beta-lactams, flagyl, clindamycin, and 3rd generation cephalosporins. 

Submitted by W. Brooks.

Refernce(s): Wikipedia; Lemierre’s Syndrome, Wright, et al, Southern Medical Journal, May 2012; picture from NEJM

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