Lemierre's Syndrome

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= Overview = Lemierre’s Syndrome refers to human necrobacillosis (infections with F. necrophorum) with primary foci in the head (oropharynx, face, ears, mastoid, teeth), often with septic thrombophlebitis of the internal jugular vein.

Differential Diagnosis

 * Descending necrotizing mediastinitis
 * Meningitis (mostly in children with otitis media
 * Beware false positive chlamydia PCR

History and Symptoms

 * Intense rigors and high fever within 1 week after primary local infection
 * Leukocytosis
 * Subclincical hyperbilirubinemia (50%)
 * Mild DIC (23%)

Ear Nose and Throat

 * Ipsilateral neck tenderness parallel with sternocleidomastoid muscle

Lungs

 * Metastatic abscesses mainly to lungs (85%), but also joints (26%)

Abdomen

 * Abdominal pain 2nd to microabscesses vs. thrombophlebitis of abdomino- pelvic veins

Echocardiography or Ultrasound

 * Unilateral suppurative thrombophlebitis of IJ: Ultrasound, CT, MRA

Acute Pharmacotherapies

 * Penicillin + Flagyl vs. Clindamycin ?
 * Debridement of necrotic tissues
 * Anticoagulation normally not advised unless clot propagates towards cavernous sinus

Acknowledgements
The content on this page was first contributed by: Stephen Wiviott, M.D.

List of contributors:

For Patients
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