Introduction: Lemierre's syndrome is a rare and less commonly occurring clinical condition that generally relates to the septic thrombophlebitis of the internal jugular vein. Common bacteria causing infection are Streptococci followed by Staphylococci and Klebsiella. The major proportion of cases that come to light are due to deep neck space infections that ultimately leads to thrombotic involvement of IJV, accounts for majority of the cases. The other causes include complications of chronic suppurative otitis media and thrombosis occurring in deep veins. Since the internal jugular vein is involved the infection can also undergo hematogenous spread. The infection generally spreads to spleen, liver, kidney, heart and brain. Lemierre's syndrome can be diagnosed on the basis of clinical symptoms, multitude of blood series and imaging. Since it is an infectious condition the treatment involves systemic antibiotic therapy and early administration of broad spectrum antibiotics in high dose become necessary for prevention of complications and systemic spread of infection. We are presenting a case series of 5 cases over a period of six years from November 2015 to November 2021.
Materials and methods: This case series focused on the cases of Lemierre's syndrome that presented in the MBS Hospital, Kota over a course of 2 years from November 2019 to November 2021. The cases that were encountered were admitted, diagnosed and treated uneventfully. The investigations that the patients underwent were: blood cultures, chest skiagrams, contrast-enhanced computed tomography (CECT), skiagrams of mastoid bone, throat cultures and thorough clinical and ENT examination.
Results: The observation and analysis of all the 5 recorded cases reveals that 2 cases of Lemierre's syndrome were having deep neck space infection as a causative factor in development of the disease and the other 2 cases were due to complications of chronic suppurative otitis media and the last remaining case had deep venous thrombosis as a causative factor for involvement of IJV and development of Lemierre's syndrome. Early administration of broad spectrum antibiotics is absolutely necessary on suspicion of Lemierre's syndrome so as to prevent adverse clinical outcome.
Lemierre A. On certain septicemias due to anaerobic organisms. Lancet 1936;227(5874):701–703. DOI: 10.1016/S0140-6736(00)57035-4
Osowicki J, Kapur S, Phuong LK, et al. The long shadow of Lemierre's syndrome. J Infect 2017;74(1):S47–S53. DOI: 10.1016/S0163-4453(17)30191-3
Chen FL, Jean SS, Ou TY, et al. Pulmonary empyema caused by co-infections of mycoplasma pneumoniae and Fusobacterium necrophorum: a rare case of Lemierre syndrome. J Microbiol Immunol Infect 2017;50(4):552–554. DOI: 10.1016/j.jmii.2016.11.007
Lee WS, Wang FD, Shieh YH, et al. Lemierre syndrome complicating multiple brain abscesses caused by extended-spectrum β-lactamase-producing klebsiella pneumonia cured by fosfomycin and meropenem combination therapy. J Microbiol Immunol Infect 2012;45(1):72–74. DOI: 10.1016/j.jmii.2011.09.012
Lin HY, Liao KH, Jean SS, et al. Lemierre syndrome with cervical spondylodiscitis and epidural abscess associated with direct injection of heroin into the jugular vein. J Microbiol Immunol Infect 2015;48(2):238–239. DOI: 10.1016/j.jmii.2013.11.008
Srivali N, Ungprasert P, Kittanamongkolchai W, et al. Lemierre's syndrome: an often missed life threatening infection. Indian J Crit Care Med 2014;18(3):170–172. DOI: 10.4103/0972-5229.128708
Gupta N, Kralovic SM, McGraw D. Lemierre syndrome: not so forgotten! Am J Crit Care 2014;23(2):176–179. DOI: 10.4037/ajcc2014975
Lee WS, Jean SS, Chen FL, et al. Lemierre's syndrome: a forgotten and re-emerging infection. J Microbiol Immunol Infect 2020;53(4):513–517. DOI: 10.1016/j.jmii.2020.03.027
Brook Itzhak. Fusobacterial head and neck infections in children. Int J Pediatr Otorhinolaryngol 2015;79(7):953–958. DOI: 10.1016/j.ijporl.2015.04.045
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):779–789. DOI: 10.1007/s10096-008-0496-4
Ramirez S, Hild TG, Rudolph CN, et al. Increased diagnosis of Lemierre syndrome and other Fusobacterium necrophorum infections at a children's hospital. Pediatrics 2003;112(5):e380–e383. DOI: 10.1542/peds.112.5.e380
Lustig LR, Cusick BC, Cheung SW, et al. Lemierre's syndrome: two cases of postanginal sepsis. Otolaryngol Head Neck Surg 1995;112(6):767–772. DOI: 10.1016/S0194-59989570192-3
Weesner CL, Cisek JE. Lemierre syndrome: the forgotten disease. Ann Emerg Med 1993;22(2):256–258. DOI: 10.1016/s0196-0644(05)80216-1
Kern W, Dolderer M, Krieger D, et al. Lemierre's syndrome with splenic abscesses. Dtsch Med Wochenschr 1992;117(40):1513–1517. DOI: 10.1055/s-2008-1062472
Celikel TH, Muthuswamy PP. Septic pulmonary emboli secondary to internal jugular vein phlebitis (postanginal sepsis) caused by Eikenella corrodens. Am Rev Respir Dis 1984;130(3):510–513. DOI: 10.1164/arrd.1984.130.3.510
Mañé S, Torres M, Bugés J, et al. Scintigraphic demonstration of jugular obstruction in a case of Lemierre syndrome. Clin Nucl Med 1992;17(3):233–235. DOI: 10.1097/00003072-199203000-00017
Carlson ER, Bergamo DF, Coccia CT. Lemierre's syndrome: two cases of a forgotten disease. J Oral Maxillofac Surg 1994;52(1):74–78. DOI: 10.1016/0278-2391(94)90019-1
