DOI:10.2214/AJR.06.0096
AJR 2006; 187:W324
© American Roentgen Ray Society
Lemierre Syndrome: An All-But-Forgotten Disease
William T. O'Brien, Sr.,
Grant E. Lattin, Jr. and
Adrianne K. Thompson
David Grant U.S. Air Force Medical Center Travis AFB, CA
94535
WEB—This is a Web exclusive article.
An otherwise healthy 21-year-old man presented to the emergency department
with a 1-week history of progressively worsening fever, chills, sore throat,
nausea, vomiting, and cough. He was toxic-appearing, tachycardic, tachypneic,
and hypotensive on arrival. Physical examination findings were significant for
erythematous, swollen tonsils without exudate and diffuse bilateral crackles
on lung auscultation. Laboratory values revealed an elevated WBC with a left
shift and findings compatible with acute kidney failure. A portable chest
radiograph showed diffuse parenchymal opacities and bilateral pleural
effusions. The patient was admitted to the ICU with the diagnosis of sepsis
and was given broad-spectrum antibiotics pending culture results.
Despite intensive monitoring and broad-spectrum antibiotic therapy, the
patient continued to decompensate, requiring endotracheal intubation.
Contrast-enhanced CT of the neck and chest was performed, revealing right
internal jugular vein thrombosis (Fig. 3A), multiple cavitary pulmonary
nodules, and bilateral pleural effusions (Fig. 3B). Thoracentesis confirmed
the suspicion of bilateral exudative effusions.
On the basis of the clinical history of a recent oropharyngeal infection
and the presence of internal jugular vein thrombosis with multiple pulmonary
septic emboli, the diagnosis of Lemierre syndrome was suspected and later
confirmed with blood cultures positive for Fusobacterium necrophorum.
After prolonged treatment with tailored antibiotic therapy and percutaneous
drainage of the bilateral exudative effusions, the patient achieved a
remarkably full recovery with restoration of baseline renal and pulmonary
functions.
Lemierre syndrome is a rare clinical entity, with fewer than 160 cases
reported since it was first described in the early 1900s
[1]. This syndrome consists of
internal jugular vein thrombosis after a primary oropharyngeal infection with
the development of distant septic emboli
[2]. The lungs are most often
affected; however, almost any organ may be involved.
Classically, Lemierre syndrome occurs in otherwise healthy adolescents and
young adults. Appropriate diagnosis is often delayed because of the initial
indolent course of the infection and the relative obscurity of the disease.
The diagnosis is made with positive blood cultures, usually F.
necrophorum, and appropriate imaging findings. Often, imaging findings
precede blood culture results; therefore, radiologists play a crucial role in
the early recognition of this syndrome
[3]. Prompt diagnosis and
treatment are necessary to prevent sepsis and subsequent death.
Note—The views expressed in this material are those of the authors
and do not reflect the official policy or position of the U.S. government, the
Department of Defense, or the Department of the Air Force.
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Fig. 1A —21-year-old man with right internal jugular vein thrombosis
and multiple pulmonary septic emboli. Axial contrast-enhanced CT scan of neck
shows thrombus occluding right internal jugular vein (arrow).
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Fig. 1B —21-year-old man with right internal jugular vein thrombosis
and multiple pulmonary septic emboli. Axial contrast-enhanced CT scan of chest
in lung window setting shows septic pulmonary emboli with cavitations and
bilateral pleural effusions.
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References
- Sara Z, Beard G, Furey W. Insight into a forgotten disease:
Lemierre's syndrome. Resid Staff Physician2005; 51:37
-40[Medline]
- Riordan T, Wilson M. Lemierre's syndrome: more than a historical
curiosa. Postgrad Med J 2004;23
: 241-245[CrossRef]
- Screaton NJ, Ravenel JG, Lehner PJ, Heitzman ER, Flower CDR.
Lemierre syndrome: forgotten but not extinct—report of four cases.
Radiology 1999;213
: 369-374[Abstract/Free Full Text]
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