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Early Radiographic Warning Signs of Impending Lemierre's Syndrome.

Richa S Nathan1, Tyler J Ostrowski2, Ananth Narayan3

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Summary

Lemierre's syndrome, a dangerous complication of head and neck infections, is rising in young adults. Early detection of subtle internal jugular vein thrombophlebitis is crucial to prevent severe outcomes.

Keywords:
head and neck infectioninternal jugular vein thrombosislemierre's syndromeradiographic findingsreactive lymphadenopathyseptic thrombophlebitissocial determinants of health

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Area of Science:

  • Infectious Diseases
  • Vascular Surgery
  • Radiology

Background:

  • Lemierre's syndrome is a rare but severe complication of head and neck infections.
  • Its incidence has increased in young adults, often linked to oropharyngeal infections.
  • Early diagnosis is challenging due to elusive initial symptoms.

Observation:

  • A case of bacterial tonsillitis rapidly progressed to Lemierre's syndrome.
  • Initial imaging showed subtle internal jugular vein micro-occlusions.
  • Within four days, complete vein occlusion and pulmonary septic emboli developed.

Findings:

  • Diagnosis confirmed by internal jugular vein thrombophlebitis on imaging and anaerobic bacteria in blood cultures.
  • Rapid progression from subtle findings to complete occlusion and emboli.
  • Highlights the importance of recognizing early thrombotic signs.

Implications:

  • Emphasizes prompt recognition and treatment of subtle thrombophlebitis in head and neck infections.
  • Suggests considering social determinants of health in infection management.
  • Underscores the need for vigilance to prevent potentially fatal outcomes of Lemierre's syndrome.