Isolated Facial Vein Thrombophlebitis Caused by Fusobacterium nucleatum: A Lemierre-Variant Case

Background: Lemierre's syndrome is an uncommon yet potentially fatal infection, classically secondary to bacterial pharyngeal infections. It is typically characterized by bacteremia, most frequently due to Fusobacterium necrophorum and internal jugular vein thrombophlebitis. If untreated, septic embolization may result, potentially damaging the lungs, liver, brain, or other organs. This report describes a variant of Lemierre's syndrome in a young woman with streptococcal pharyngitis, who developed Fusobacterium nucleatum bacteremia and isolated facial vein thrombophlebitis, highlighting the importance of early diagnosis and treatment. Case Presentation: A 33-year-old woman with no significant past medical history presented with sore throat, chills, and right-sided facial and neck pain. Initially diagnosed with streptococcal pharyngitis at an urgent care clinic, she presented to the emergency department soon afterwards due to the development of severe rigors and fever. Blood cultures revealed growth of Fusobacterium nucleatum, raising suspicion for Lemierre's syndrome in the setting of worsening facial and neck pain despite negative initial imaging of the soft tissue of the neck. A subsequent CT venogram confirmed isolated thrombosis of the right facial vein. The patient was treated and discharged in stable condition on a 4 week course of metronidazole and 2 weeks of ceftriaxone. Conclusion: This case emphasizes the importance of maintaining suspicion for Lemierre's syndrome in patients with bacterial pharyngitis, especially when atypical symptoms such as facial pain occur. Although the internal jugular vein is most commonly affected, facial vein thrombosis may also occur. Early antibiotic treatment is critical for preventing severe complications including septic shock and embolization.