Abstract
Lemierre’s syndrome is characterized by oropharyngeal infection, thrombophlebitis of the internal jugular vein, systemic organ thromboembolism, and a high mortality rate. The most involved distant sites are the lungs, joints, bones, skin, and soft tissue. Central nervous system (CNS) complications occur in 3% of cases. A 62-year-old male was rushed to our emergency department due to chills and immobility. Contrast-enhanced computed tomography showed a right parapharyngeal space abscess, which was drained. Thereafter, antibiotic therapy was started. Blood and abscess cultures on admission revealed Streptococcus constellatus. After admission, hemichorea and psychiatric symptoms appeared. Cerebrospinal fluid examination and contrast-enhanced magnetic resonance imaging revealed meningitis, encephalitis, subdural abscess, and sigmoid sinus thrombosis. In addition to antibiotic therapy, anticoagulation therapy was started, and thrombosis was resolved. Hemichorea and psychiatric symptoms were thought to be caused by inflammatory spillover to the subthalamic nucleus. Although hemichorea improved, psychiatric symptoms persisted. When treating Lemierre’s syndrome, physicians should be aware of the possibility of CNS complications.
