Thrombophlebitis of the internal jugular vein and bacteremia caused by primarily anaerobic organisms, following a recent oropharyngeal infection with subsequent systemic septic foci
- 1936 this disease was named after Dr. Andre Lemierre
- Disseminated abscesses after infection of the oropharynx.
- It is commonest in young healthy adults.
- Thrombophlebitis of the internal and possible external jugular vein
- Local invasion of the lateral pharyngeal space
- Septic thrombophlebitis of the Internal Jugular vein.
- Most due to Fusobacterium necrophorum
- Metastatic infections to Lung, liver, muscle, pericardium, brain and skin
- Fusobacterium necrophorum, hence also known as necrobacillosis
- Group B and C Streptococcus
- Enterococcus species
- Proteus has also been isolated
- Often young healthy children and adults with prolonged symptoms of pharyngitis
- Fever, pharyngitis, dysphagia, odynophagia,
- Severe pain from oropharyngeal infection
- Focal neurology from Brain abscesses
- Localised lymphadenopathy and septicaemia
- Evidence of jugular vein thrombosis
- Horner's syndrome has been also seen as a complication.
- The predominant pathogen is a gram-negative anaerobic bacillus.
- Fusobacterium necrophorum is a common culprit organism
- It can be isolated from blood culture
- However some may be due to streptococcus.
- May just find a polymicrobial flora consisting of both aerobic and anaerobic bacteria
- FBC, U&E, LFTs, CRP - signs of sepsis
- Blood culture: growth of anaerobic bacteria on blood culture.
- ECG: tachycardia
- CXR shows several foci of consolidation and cavitation and effusions.
- Doppler USS of both the external and the internal jugular veins if thrombosis suspected
- CT Neck with contrast may show extensive inflammation of the pharynx and jugular vein thrombosis
- ABC, IV Access, Start Broad spectrum antibiotics
- Anticoagulate - Consider LMWH
- Consider Anaesthetic/ENT input if airway issues
- Prolonged Antibiotics: Metronidazole, clindamycin