Lemierre syndrome is caused by an acute oropharyngeal infection associated with secondary septic thrombophlebitis of the internal jugular vein, frequently complicated by metastatic infections to the lungs or large joints.

A previously healthy and fully immunized 1½ year old girl was admitted with fever, neck pain and moderate dyspnea for four days. On examination, there was bilateral anterior cervical lymphadenopathy and tender swelling in the left laterocervical region extending from the angle of jaw and parallel to the sternocleidomastoid muscle. Laboratory analysis showed a non specific inflammatory reaction with leucocytosis and elevated ESR. Throat cultures were negative for Corneybacterium diphtheriae and beta hemolytic streptococci. The chest X-ray showed bilateral perihilar infiltrates indicating metastatic infection from oropharynx. Color doppler ultrasonography of the neck revealed thrombophlebitis of left internal jugular vein. A diagnosis of Lemierre syndrome was made. The child was treated with crystalline penicillin and chloramphenicol, metronidazole and low molecular weight heparin. Blood cultures were sterile. Serial radiologic follow up revealed resolution of the thrombus over time.

Fusobacterium necrophorum is the etiological agent in over 80% of cases of Lemierre’s syndrome(1). We did not isolate this organism, as we had already started antibiotics before the blood culture was taken. The palatine tonsils and peritonsillar tissue are the primary source of infection in the majority, although pharyngitis, otitismedia and mastoiditis have been described(2,3). Lungs are the most common sites of embolic disease(3). A tender swelling at the angle of the jaw and parallel with the sternocleidomastoid muscle reflects the development of thrombophlebitis of the internal jugular vein. The mainstay of treatment is prolonged intravenous antibiotics directed at anaerobic microbes and therapeutic anticoagulation.