Lemierre’s syndrome is a rare and potentially life-threatening condition that follows an oropharyngeal infection, typically from Fusobacterium necrophorum, and usually affects healthy adolescents or young adults. The characteristic features are septic thrombophlebitis of the internal jugular vein and septic embolism leading to multiorgan involvement, commonly the brain, lungs and bones. We report a man with presenting symptoms suggesting hemicrania continua, whose initial imaging showed no features of dural venous sinus or jugular thrombosis. Two weeks later, he had fever, sore throat, cervical lymphadenopathy and Actinomyces meyeri grew from peripheral blood cultures. Further imaging identified thrombosis of the internal jugular vein and cerebral venous sinuses, with multifocal cavitating lung lesions. Following antibiotics and anticoagulation, he recovered without residual deficits. Lemierre’s syndrome when recognised and treated early has a good prognosis but delayed treatment may result in significant morbidity or mortality.
- sinus thrombosis
- clinical neurology
- infectious diseases
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Contributors Drafting of the manuscript and literature review: ECF and MT. Critical revision of the manuscript: ECF, MT, HC and MR. Acquisition, analysis or interpretation of radiographic images: HC. Patient review, diagnosis, and management: ECF and MR.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Provenance and peer review. Not commissioned. Externally peer reviewed by Holger Allroggen, Coventry, UK.