Lemierre Syndrome

Question 1

What is Lemierre syndrome?

Answer 1

Thrombophlebitis of the jugular veins with distant septic mets in the setting of oropharyngeal infection

Question 2

Pathogens most commonly responsible for Lemierre?

Answer 2

1. Fusobacterium necrophorum
2. 30% polymicrobial
3. Anaerobic streps / G-ve anaerobes

Question 3

CFx Lemierre syndrome?

Answer 3

• Trismus
• pain behind angle of jaw
• neck swelling

Question 4

US Fx Lemierre syndrome?

Answer 4

Thrombus within jugular vein / other neck or facial veins

Question 5

Fx to identify on CECT Lemierre syndrome?

Answer 5

• Intraluminal filling defect JV
• Sites of septic emboli (usu pulmonary)
• Site of primary infection

Question 6

Ages commonly affected?

Answer 6

Young adults or adolescent

Question 7

Common cause of sepsis in Lemierre?

Answer 7

• Tonsillar or peritonsillar abscess and

- thrombophlebitis of the tonsillar or peritonsillar veins (spreads to IJV/facial vein)

Question 8

Causes of IJV thrombosis?

Answer 8

• CVC
• IVDU
• Hypercoaguability
• Infection
• Atherosclerosis

Question 9

CFx IJV thrombosis?

Answer 9

• Swelling/tenderness along SCM and angle of mandible

- +/- cellulitis, trismus, dysphagia

Question 10

Most common sites of septic mets?

Answer 10

Lungs and joints

can go to liver, soft tissue, bone

Question 11

Rx lemierre?

Answer 11

Fusobacterium usu respond to:
-Penicillin G
-Anerobic cover (metronidazole, clindamycin, cefoxitin, chloramphenicol)
Prolonged Rx (as endovascular)