A rare case report of Lemierre syndrome originating from an impacted maxillary third molar

Lemierre syndrome is characterized by clinical or radiographic signs of thrombosis of the internal jugular vein, distant infected emboli and the presence of anaerobic pathogens, usually Fusobacterium necrophorum. It can be the result of a recent infection in the area of the head or neck, mostly in the form of pharyngitis or tonsillitis. It can also result from less common conditions, such as odontogenic infections which is rarely reported in the dental literature.

This article reports the clinical case of a 69-year-old male patient with a persistent diffuse swelling in the facial and neck area with throat pain, associated to an odontogenic sinusitis, that was later diagnosed as Lemierre's syndrome caused by an impacted maxillary wisdom tooth.

Diagnosis of Lemierre syndrome is challenging. Suspicion of the disease is needed in cases of oropharyngeal infection followed by fever, tender swelling of the neck sore throat and dysphagia. Screening for thrombosis of the internal jugular vein may be quickly accomplished using ultrasonography; however, a computed tomography scan is more sensitive for identifying this entity. Successful management of this condition relies on knowledge of the condition and its prompt diagnosis. This usually needs surgical drainage and intravenous antibiotics. Anticoagulation is controversial.

Morbidity and mortality are significant with this syndrome, that is why diagnosis and early treatment are very important, and dentists should be familiar with this condition.