Vol. 101  No. June  2008

A Case of Lemierre Syndrome

Hiroshi Nakanishi, Seiji Hosokawa, Kunihiro Mizuta and Hiroyuki Mineta
(Hamamatsu University School of Medicine)

Maki Arai
(Social Insurance Hamamatsu Hospital)

Satoshi Iwasaki
(Hamamatsu Red Cross Hospital)

We present a case of Lemierre syndrome characterized by thrombophlebitis of the internal jugular vein with multiple septic emboli to the lung caused by peritonsillar abscess.
A 67-year-old male was admitted with progressive fever and sore throat caused by peritonsillar abscess. Despite drainage of the peritonsillar abscess and antibiotic therapy with imipenem following cefozopran, his condition worsened, and he presented with swelling, pain, and erythema of the right side of the neck. Contrast-enhanced computed tomography (CT) of the neck demonstrated thrombosis of the right internal jugular vein. CT scan of the thorax showed bilateral multiple septic emboli. Based on these findings, a diagnosis of Lemierre syndrome was made. The patient was treated with clindamycin and heparin in addition to imipenem and recovered slowly.
Lemierre syndrome is one of the complications of acute tonsillitis or peritonsillar abscess, which causes thrombophlebitis of the internal jugular vein, leading to metastatic abscess, septic emboli, and significant mortality. Lemierre syndrome should be considered in cases of acute tonsillitis or peritonsillar abscess because the frequency of this syndrome is increasing.

Key words :
Lemierre syndrome, peritonsillar abscess, thrombophlebitis, septic emboli

第101巻6号 目次   Vol.101 No.6 contents