Lemierre's Syndrome in a Commercial Airline Pilot

Lemierre's syndrome (LS) is a rare, life-threatening complication of an acute oropharyngeal infection. It is commonly associated with pharyngitis caused by Fusobacterium necrophorum, which can lead to septic thrombophlebitis of the internal jugular vein. Subsequently, septic emboli usually form, which can metastasize to the liver, lungs, endocardium, and joints. The role of anticoagulation in LS remains debated and there is no universal consensus on best practice.

A 39-yr-old commercial pilot, flying air cargo operations in Australia, presented to the emergency department with a sore throat, was given antibiotics, and then discharged. He re-presented 2 d later with fever and increased painful swelling of the right lateral neck. A CT scan showed gas-forming thrombophlebitis in the superior sagittal sinus, right transverse sinus, and right internal jugular vein. He was started on broad-spectrum antibiotics and on anticoagulation with enoxaparin. Initial control of the infection was challenging despite antibiotics, requiring a staged surgical exploration and washout of the neck. After reintervention, the patient made an excellent recovery. However, given his anticoagulation, he had to wait several months for clearances from various specialties before the Australian and New Zealand aviation authorities allowed him to fly commercially again.

There is currently no consensus in the medical literature on the timing, duration, dosing, or type of anticoagulant for LS, making it challenging to publish unified recommendations for Aviation Medical Examiners. This case report highlights the importance of an individualized approach to prevent unjustified grounding of pilots on anticoagulation. Fandino A, Woodbridge C, Back G, Sprott T. Lemierre's syndrome in a commercial airline pilot. Aerosp Med Hum Perform. 2026; 97(4):296-299.