Abstract
Lemierre's syndrome is a serious infectious disease characterized by thrombophlebitis of the internal jugular vein and thrombosis propagating into the lungs and other organs following a prolonged history of bacterial pharyngitis. If this uncommon condition is suspected, preemptive broad-spectrum antibacterial therapy should be initiated immediately to prevent enlargement and propagation of the inflammation. This paper describes a patient with Lemierre's syndrome who presented with pyrexia and dyspnea and was diagnosed by the identification of left internal jugular venous thrombosis, Gram-negative anaerobic (primarily, Fusobacterium necrophorum) bacteremia, and bilateral pleural effusion and empyema. Prompt antimicrobial therapy ameliorated the general condition of the patient, while intrapleural instillation of urokinase with chest drainage successfully treated the empyema. This experience re-emphasizes the importance of early and appropriate interventions for the cure of this syndrome and suggests that in case of coexistence of empyema, intrapleural fibrinolytic therapy with chest drainage is worth trying because of its reduced risk of inducing systemic adverse effects.
