Post-cholesteatoma Lemierre syndrome: An emergency not to be overlooked

Lemierre syndrome is a bacterial complication causing septic thrombosis of the head-and-neck venous network, usually with an oropharyngeal origin. Onset after otologic surgery is exceptional.

A 33-year-old woman underwent tympanoplasty for cholesteatoma; 13 days later, she developed sepsis with retroauricular scar disunion. Progression showed septic shock secondary to hemorrhagic rupture of the thrombotic lateral sinus, associated with acute respiratory distress and septic pulmonary emboli. Management required intensive care, revision surgery, antibiotic therapy and anticoagulation.

This was a rare and serious form of Lemierre syndrome of otologic origin. It highlights the importance of considering this diagnosis in all cases of postoperative ENT sepsis with associated venous thrombosis. Treatment is based on adapted antibiotic therapy. The role of anticoagulation is debatable in the absence of solid evidence of benefit in terms of repermeabilization or survival.