P.031 Lemierre’s syndrome - a rare disease with devastating complications

Background: Lemierre’s syndrome is a rare but serious complication of bacterial oropharyngeal infection. It is characterized by local spread of the primary infection, thrombophlebitis of the internal jugular vein, and septic metastases resulting in significant multi-system complications. Methods: A case report. Results: A previously healthy 63 year-old female presented to our emergency room with four-day history of sore throat, headache, fever and malaise. Initial examination revealed evidence of left tonsillar swelling and cervical lymphadenopathy. The patient rapidly deteriorated within hours of presentation and developed septic shock that was complicated by an acute kidney injury and disseminated intravascular coagulation (DIC). CT of the head and neck revealed a deep abscess within the left masticular triangle extending to surrounding soft tissue as well as C1-C3 epidural space. An extensive bilateral internal jugular vein thrombosis was noted; extending into the sigmoid and cavernous sinuses bilaterally. A thrombosis of the superior sagittal sinus and parafalcine subdural hematoma were also demonstrated. Blood cultures grew Group C Streptococcus. As the deep abscess was not amenable to surgical drainage, the patient was treated with broad-spectrum IV antibiotics. Anticoagulation was also commenced after management and resolution of the DIC. Conclusions: Lemierre’s syndrome remains relevant nowadays and awareness of its potential neurological complications is warranted.