A Case of Suspected Lemierre Syndrome

Abstract

A 57-year-old woman often experienced toothache and gingivitis because of dental caries. She was admitted to our hospital with a 12-day history of right headache and neck pain. She also had low-grade fever, and the blood count showed leucocytosis on the first day. The patient was treated with intravenous antibiotics for infection. Whole-body contrast CT revealed multiple cerebral nodules, thrombus in the branches of the right internal jugular vein, mild left tonsil swelling, and multiple pulmonary nodules. Additional anticoagulant therapy was started to avoid the intracranial progression. The blood culture was negative and the origin was still unknown, but we suspected Lemierre syndrome from these examination results. The follow-up chest X-ray revealed the disappearance of lung nodules, and she was discharged on the 30th day. Lemierre syndrome is not only rare but is also frequently fatal. We should perform the examination and treatment with careful attention particularly in young cases with oral or oropharyngeal infection causing metastatic disease.