Really just a pharyngitis?

Lemierre syndrome is defined as a pharyngitis with a thrombophlebitis of the right jugular vein. The common pathogen is fusobacterium necrophorum. A 25 years old female patient with dysphagia and fever presented to our emergency department. The physical examination showed hypertrophic tonsils with purulent coating, more on the right tonsil, accompanied by redness of the palatal arches. The neck presented painful swollen lymph nodes. The patient was admitted to the hospital. We started an intravenous antibiotic-therapy with cephazolin. On the next day the patient developed a sepsis with a respiratory decompensation (Early-Warning-Score 7, O2 88%, T 38.9°C, HR 122/min, BP 104/61 mmHg), she was immediately transferred to the intensive care unit. The CT scan of the neck and thorax showed a right sided peritonsillar abscess, a thrombophlebitis of the right internal jugular vein and pulmonary infiltrates on both sides. We performed an emergency abscess tonsillectomy on the right side. Due to a respiratory failure of the patient an intubation and artificial ventilation was necessary. The antibiotic-therapy was swichted to piperacillin/tazobactam and clindamycin. Blood cultures showed an infection with fusobacterium necrophorum, which led to the diagnosis Lemierre syndrome. This case report shows that an infection with fusobacterium necrophorum can lead to a fulminant progression on a patients condition and should kept in mind, when there is a clinical deterioration under a calculated antibiotic-therapy.

Publication History

Article published online:
27 June 2023