Recurrence of Lemierre's Syndrome Presenting With Extensive Cerebral Venous Sinus Thrombosis: A Case Report

Lemierre's syndrome is a rare but potentially life-threatening condition characterised by septic thrombophlebitis of the internal jugular vein following oropharyngeal infection, most commonly caused by Fusobacterium necrophorum. Although it typically affects young, otherwise healthy adults, recurrent or chronic presentations in older individuals are uncommon and diagnostically challenging. We report a 43-year-old male with a prior episode of Lemierre's syndrome secondary to a peritonsillar abscess complicated by left internal jugular vein thrombosis and septic pulmonary emboli, who presented with severe left-sided headache, neck pain, vomiting, and transient visual disturbances following recent antibiotic treatment for presumed tonsillitis. Imaging revealed extensive cerebral venous sinus thrombosis involving the superior sagittal, transverse, and sigmoid sinuses, without evidence of active oropharyngeal infection or septic focus. The patient had discontinued long-term anticoagulation six weeks before admission because of medication unavailability and a possible drug-related rash. He was treated with therapeutic-dose enoxaparin during admission and was subsequently transitioned back to rivaroxaban upon discharge, with follow-up imaging demonstrating partial recanalisation of the affected sinuses. This case highlights the potential for recurrent or chronic thrombotic complications of Lemierre's syndrome in the absence of overt infection and underscores the importance of sustained anticoagulation, early recognition of cerebral venous sinus involvement, and multidisciplinary follow-up to prevent late complications in high-risk patients.