A Case of Thrombophlebitis of the Internal Jugular Vein without Metastatic Abscess and Septic Emboli

Abstract

A 45-year-old woman was referred to our department with sore throat, swelling of the lower left chin and high fever even after four days of oral antibiotics treatment in a private clinic. She had redness and swelling along her left sternocleidomastoid muscle from the lower left ear to the sternum. Her laboratory test showed an elevated white blood cell count and elevated C-reactive protein (CRP), but the results of the test did not satisfy the criteria of disseminated intravascular coagulation. Contrast enhanced computed tomography showed a left deep neck abscess and thrombosis of the left internal jugular vein (IJV) from the level of the transvers process of the second cervical spine to that of venous angle. She did not have mediastinum abscess, pulmonary emboli, and liver and spleen abscess, however, that are often observed in Lemierre’s syndrome. She did not complain of arthralgia in her large joints. Under the diagnosis of pharyngitis with deep neck abscess and thrombophlebitis of the IJV, she was given intravenous ampicillin/sulbactam (ABPC/SBT). On the third day of her admission, she underwent drainage of the left deep neck abscess because of gas production. Peptostreptococcus was detected from a blood culture which was sensitive to ABPC/SBT. Intravenous ABPC/SBT treatment was continued for 35 days until we confirmed the total control of the infection and the IJV thrombosis had stabilized.
The patient experienced less severe symptoms than typical Lemierre’s syndrome cases probably due to early treatment with an appropriate intravenous antibiotic, an atypical pathogen, and onset at an atypically older age.