Lemierres Syndrome in Pregnancy Secondary to Retropharyngeal Abscess

Lemierres syndrome (LS) refers to suppurative thrombophlebitis of internal jugular vein (IJV) secondary to oropharyngeal infection. It is caused by the anaerobic bacteria Fusobacterium necrophorum. Here we report a case of LS secondary to retropharyngeal abscess in a pregnant lady with possible underlying connective tissue disorder. A 19-year old primigravida at 6-weeks of gestation, presented with fever, cough, dyspnea, right sided neck pain and swelling. Imaging showed right lower lobe pneumonia with bilateral pulmonary infiltrates and pleural effusion. Ultrasound of the neck showed right IJV thrombosis. Magnetic resonance imaging of the neck revealed a retropharyngeal abscess extending from C1 to C4 vertebral level. She had positive ANA, SS-A and Ro-52 titres. She was treated with piperacillin-tazobactam, metronidazole, enoxaparin and short course steroids. Even though she improved initially, fever recurred and she had a massive hemoptysis with hemothorax and expired.