A Complex Case of Lemierre's Syndrome With Facial Vein Involvement

Lemierre's syndrome is a rare disease that generally occurs in young, healthy individuals, where an index of suspicion for something so serious is often low. There is no standardized definition of Lemierre's syndrome, which has led to a dilemma if Lemierre's can be diagnosed without internal jugular vein (IJV) thrombophlebitis. We highlight a complex case of Lemierre's syndrome that deviates from the classical presentation of the disease. A 31-year-old male presented to the hospital with "throat swelling" and difficulty swallowing. He was in severe sepsis with end-organ damage. The patient developed severe pneumonia with pleural/pericardial effusions and bilateral nodular necrosed lesions during hospitalization. A facial vein thrombus was diagnosed, but the absence of internal jugular vein involvement initially delayed Lemierre's diagnosis. However, blood culture speciation revealed Fusobacterium necrophorum, which supported the suspected diagnosis. Persistent fevers and leukocytosis complicated the hospital course despite appropriate antibiotic coverage. The patient ultimately required bilateral thoracotomy and a pericardial window. He made a full recovery.