Abstract

The presentation of a ‘sore throat’ is common and often requires only symptomatic treatment. This is the case of a 20-year-old female who presented with persistent symptoms of a sore throat. On admission she had raised inflammatory markers and a subsequent blood culture demonstrated a fusobacterium necrophorum and arcanobacterium haemolyticum bacteraemia. Further investigations established an internal jugular vein thrombosis, confirming the diagnosis of Lemierre’s syndrome. This case highlights the importance of further investigation when a sore throat fails to improve, and to remember this often-forgotten syndrome.

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References

1. Karkos PD, Asrani S, Karkos CD, et al; Lemierre’s Syndrome: A Systematic Review. Laryngoscope 2009; 119(8): 1552-1559.
2. Brazier JS, Hall V, Yusuf E, et al. Fusobacterium necrophorum infections in England and Wales 1990–2000. J Med Microbiol 2002; 51: 269–72.
3. Lemierre A; On certain septicaemias due to anaerobic organisms. Lancet 1936; 1(5874): 701-703.
4. Righini CA, Karkas A, Tourniaire R, et al. Lemierre syndrome: study of 11 cases and literature review. Head Neck. 2014; 36(7):1044-51.
5. Jensen A, Hagelskjaer Kristensen L, Prag J; Detection of Fusobacterium necrophorum subsp. funduliforme in tonsillitis in young adults by real-time PCR. Clin Microbiol Infect 2007; 13(7): 695-701.
6. Riordan T; Human Infection with Fusobacterium necrophorum (Necrobacillosis), with a Focus on Lemierre’s Syndrome. Clin Microbiol Rev 2007; 20(4): 622-659.
7. Johannesen KM, Bodtger U; Lemierre’s syndrome: current perspectives on diagnosis and management. Infect Drug Resist 2016; 9: 221–227.
8. Hagelskjaer LH1, Prag J, Malczynski J, et al. Incidence and clinical epidemiology of necrobacillosis, including Lemierre’s syndrome, in Denmark 1990-1995. Eur J Clin Microbiol Infect Dis. 1998; 17(8):561-5.
9. Hagelskjaer LH, Kristensen L, Prag J. Human necrobacillosis, with emphasis on Lemierre’s syndrome. Clin Infect Dis 2000; 31: 524–32.
10. Yusuf E, Halewyck S, Wybo I, et al. Fusobacterium necrophorum and other Fusobacterium spp. isolated from head and neck infections: A 10-year epidemiology study in an academic hospital. Anaerobe. 2015;34: 120-4.
11. Dool H, Soetekouw R, van Zanten M, et al. Lemierre’s syndrome: three cases and a review. Eur Arch Otorhinolaryngol 2005; 262: 651–654.
12. Wright WF, Shiner CN, Ribes JA. Lemierre syndrome. South Med J. 2012; 105(5): 283-8.
13. Hagelskjaer Kristensen L, Prag J. Lemierre’s syndrome and other disseminated Fusobacterium necrophorum infections in Denmark: a prospective epidemiological and clinical survey. Eur J Clin Microbiol Infect Dis. 2008; 27(9): 779-89.
14. Riordan T. Human Infection with Fusobacterium necrophorum (Necrobacillosis), with a Focus on Lemierre’s Syndrome. Clin Microbiol Rev. 2007; 20(4): 622–659.
15. Riordan T, Wilson M. Lemierre’s syndrome: more than a historical curiosa. Postgrad Med J. 2004; 80(944): 328–334.
16. Bergeron MG, Robert J, Beauchamp D. Pharmacodynamics of antibiotics in fibrin clots. J Antimicrob Chemother. 1993; 31 Suppl D: 113-36.
17. Bondy P, Grant T. Lemierre’s Syndrome: What Are the Roles for Anticoagulation and Long-Term Antibiotic Therapy. Ann Otol Rhinol Laryngol. 2008; 117(9): 679-83.
18. Leugers C, Clover R: Lemierre syndrome: Postanginal Sepsis. J Am Board Fam Pract. 1995, 8(5): 384–391.