Lemierre's Syndrome Caused by Streptococcus milleri Group

Area of Science:

• Otolaryngology
• Infectious Diseases
• Neurology

Background:

• Lemierre's syndrome is a rare but serious complication of oropharyngeal infections, often involving the internal jugular vein.
• Sphenoid sinusitis, inflammation of the sphenoid sinuses, can serve as a primary source for such infections.

Observation:

• A 64-year-old female presented with headache, fever, unilateral ocular protrusion, hyperemia, and neck tenderness.
• Cranial MRI revealed high DWI signals in sphenoid sinuses and contrast defects in the internal jugular and superior ophthalmic veins.

Findings:

• Blood and CSF cultures identified Streptococcus milleri group as the causative agent.
• The patient was diagnosed with Lemierre's syndrome secondary to sphenoid sinusitis.
• Despite initial antibiotic and anticoagulant therapy, complications including a duodenal ulcer and brain abscess occurred.

Implications:

• This case highlights the importance of recognizing sphenoid sinusitis as a potential trigger for Lemierre's syndrome.
• Multidisciplinary management, integrating endoscopic and surgical approaches, is vital for successful treatment outcomes.
• Early diagnosis and aggressive intervention are critical for improving survival rates in complex infectious cases.