Lemierre's syndrome: a serious complication of an odontogenic infection

Necrobacillosis, postanginal septicaemia or Lemierre's Syndrome is characterised by suppurative thrombophlebitis of the internal jugular vein with embolization to several sites, including the lungs. We report the case of a 38-year-old man who was initially hospitalized because of odontogenic cellulitis. Given the deterioration of his clinical state (septic shock and multiple organ failure), neck computed tomography was performed, revealing both cervical and parotid abscesses, and thrombosis of the right internal jugular vein. Streptococcus salivarius was isolated. The patient was treated with intravenous antibiotics, and surgical drainage and after 6 weeks of treatment, recovered completely. Lemierre's Syndrome is an uncommon, but potentially lethal complication of an odontogenic infection. The case reported here is interesting since the pathogen and the site of primary infection are unusual. Fusobacterium necrophorum is the most common pathogen in Lemierre's Syndrome, and to the best of our knowledge there are no similar case reports with Streptococcus salivarius as the causative bacteria. Early recognition and high-dose antibiotics are critical elements in reducing mortality.