Case: 162

Lemierre's Syndrome

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History: 20 yo male with history of sore throat and cough who has become rapidly septic and short of breath.
Solution: Lemierre's Syndrome is thrombophlebitis of the jugular vein usually with fusobacterium that extends into the vein from a peritonsillar abscess associated with a streptococcal infection. The infected thrombus can then embolize into the lungs, creating septic emboli that can cause pulmonary abscesses. In this case, there are supparative nodes in the neck, with thrombosis of the right jugular vein and cavitary pulmonary abscesses from septic emboli. This condition usually affects young, otherwise healthy patients and is treated with antibiotics. The role of anticoagulation is unclear.

CT Images

Questions

The most appropriate next step in management is:
  • Surgery
  • Antibiotics
  • Biopsy
  • Anticoagulation
  • Supportive care
This is a rare condition that is almost always fatal.
False
What is the most likely diagnosis? Please be specific.
Lemierre's Syndrome