Lemierre's syndrome

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Background

Epidemiology

  • Very rare, incidence rate of 0.8 cases per million in the general population[2]
  • When diagnosed, mortality is 4.6%[3]

Clinical Features

Differential Diagnosis

  • Q fever
  • Tuberculosis
  • Pneumonia
  • Viral pharyngitis
  • Mononucleosis-like illnesses (EBV, CMV, acute HIV)
  • PTA vs. RA vs. Ludwig's
  • Mumps
  • Sjogren's
  • Heerfordt's syndrome (small percentage of sarcoidosis)

Acute Sore Throat

Bacterial infections

Viral infections

Noninfectious

Other

Evaluation

Workup

Evaluation

  • Diagnostic criteria
    • History of oropharynx pain within last 4 wks
    • Evidence of IJV thrombophlebitis/carotid sheath
    • Isolation of F. necrophorum from blood
    • Evidence of metastatic infection in another site (lungs)

Management

  • Antibiotics (coverage of F. necrophorum, strep, bacteroides) - Unasyn, Zosyn, or carbapenam for at least 3-4 wks
  • Drainage of abscess
  • Consider ligation of the internal jugular vein where antibiotic can not penetrate.[5]
  • No evidence for or against anticoagulation[6]

Disposition

  • Admit

See Also

Video

References

  1. "Lemierre syndrome" at Dorland's Medical Dictionary
  2. Sibai K, Sarasin F (2004). "Lemierre syndrome: a diagnosis to keep in mind". Revue médicale de la Suisse romande (in French) 124 (11): 693–5. PMID 15631168.
  3. Centor RM. "Expand the Pharyngitis Paradigm for Adolescents and Young Adults." Ann Intern Med. 2009;151(11):812-815. doi:10.7326/0003-4819-151-11-200912010-00011
  4. Melio, Frantz, and Laurel Berge. “Upper Respiratory Tract Infection.” In Rosen’s Emergency Medicine., 8th ed. Vol. 1, n.d.
  5. Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ (November 2002). "The evolution of Lemierre syndrome: report of 2 cases and review of the literature". Medicine (Baltimore) (Lippincott Williams & Wilkins) 81 (6): 458–465. doi:10.1097/00005792-200211000-00006. PMID 12441902.
  6. Puymirat E, Biais M, Camou F, Lefèvre J, Guisset O, Gabinski C (March 2008). "A Lemierre's syndrome variant caused by Staphylococcus aureus". American journal of emergency medicine test (Elsevier) 26 (3): 380–387. doi:10.1016/j.ajem.2007.05.020. PMID 18358967.