Lemierre's syndrome: literature review

Our aim was to recall the pathogenesis, clinic aspects and therapeutic options for Lemierre's syndrome. This was a retrospective study (1998-2005) of 4 patients, 3 males and 1 female, average age 22 years (18-30). Bacteriological samples, a chest radiograph and a cervical and thoracic CT-scan with injection were available for all patients who were given broad spectrum antibiotic therapy for 3 to 6 weeks. Surgical treatment was necessary for 3 patients. A review of the literature from Medline was performed. Three patients had a peritonsillar abscess. All of them exhibited thrombophlebitis of the internal jugular vein or one of its tributary branches. In all patients, metastatic infections were noted. In one, arthritis and mediastinitis were associated. The causal microorganism was Fusobacterium (necrophorum--2, nucleatum--1) in three patients. In one, bacteriological samples were negative. Transfer to an intensive care unit was necessary for one patient. There were no deaths. Lemierre's syndrome is a rare but acute medical condition which concerns young immunocompetent people. The pathogenesis consists of the development of infectious thrombophlebitis in the internal jugular vein or one of its tributary branches caused by a focal sepsis, localized in most the cases in the oropharynx, leading to metastatic infections, generally to the lung. Treatment is medical but surgery is sometimes required.