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Postpharyngitis Venous Thrombosis (Lemierre)
Bronwyn E. Hamilton, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Postanginal sepsis, necrobacillosis
                • Also called "forgotten disease"
              • Definitions

                • Opportunistic infection causing septic thrombophlebitis & metastatic infection
                  • Complication of recent pharyngotonsillitis or other upper respiratory infection (sinus, ear)

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        • Reporting Tips

                                          Selected References

                                          1. Adedeji A et al: Anticoagulation strategies in the management of Lemierre syndrome: a systematic review of the literature. Ann Pharmacother. 1060028020957620, 2020
                                          2. Gore MR: Lemierre syndrome: a meta-analysis. Int Arch Otorhinolaryngol. 24(3):e379-85, 2020
                                          3. Howley F et al: Late presentation of 'Lemierre's syndrome': how a delay in seeking healthcare and reduced access to routine services resulted in widely disseminated Fusobacterium necrophorum infection during the global COVID-19 pandemic. BMJ Case Rep. 13(10), 2020
                                          4. Moretti M et al: Lemierre's syndrome in adulthood, a case report and systematic review. Acta Clin Belg. 1-11, 2020
                                          5. Nygren D et al: Invasive infections with Fusobacterium necrophorum including Lemierre's syndrome: an 8-year Swedish nationwide retrospective study. Clin Microbiol Infect. 26(8):1089.e7-9.e12, 2020
                                          6. Repper DC et al: A case of Lemierre syndrome in the era of COVID-19: all that glitters is not gold. Pediatr Infect Dis J. 39(12):e445-7, 2020
                                          7. Shires CB et al: Multiplanar computed tomography reconstruction to diagnose Lemierre's syndrome. OTO Open. 4(3):2473974X20940692, 2020
                                          8. Ulanovski D et al: Medical and surgical characteristics of fusobacterium necrophorum mastoiditis in children. Int J Pediatr Otorhinolaryngol. 138:110324, 2020
                                          9. Valerio L et al: Lemierre syndrome: Current evidence and rationale of the bacteria-associated thrombosis, Thrombophlebitis and LEmierre syndrome (BATTLE) registry. Thromb Res. 196:494-9, 2020
                                          10. Valerio L et al: Patients with Lemierre syndrome have a high risk of new thromboembolic complications, clinical sequelae and death: an analysis of 712 cases. J Intern Med. 289(3):325-39., 2020
                                          11. Davidoss N et al: Lemierre's syndrome - an unusual complication of otitis externa in a young, healthy female. J Laryngol Otol. 129 Suppl 1:S60-2, 2015
                                          12. Hama Y et al: Slowly progressive Lemierre's syndrome with orbital pain and exophthalmos. J Infect Chemother. 22(1):58-60, 2015
                                          13. Shiber J et al: Incomplete Lemierre syndrome. Pediatr Emerg Care. 31(1):39-41, 2015
                                          14. Behpour-Oskooee M et al: Lemierre's syndrome with double heterozygote status in the methylenetetrahydrofolate reductase gene. World J Pediatr. 10(3):281-3, 2014
                                          15. Cheng J et al: Fusobacterium necrophorum in a pediatric retropharyngeal abscess: A case report and review of the literature. Ear Nose Throat J. 93(12):E22-4, 2014
                                          16. Gunatilake SS et al: Lemierre's syndrome secondary to community-acquired methicillin-resistant Staphylococcus aureus infection presenting with cardiac tamponade, a rare disease with a life-threatening presentation: a case report. Int J Emerg Med. 7:39, 2014
                                          17. Gupta T et al: The forgotten disease: Bilateral lemierre's disease with mycotic aneurysm of the vertebral artery. Am J Case Rep. 15:230-4, 2014
                                          18. Ratnasingham Y et al: Arterial ischemic stroke as a complication to disseminated infection with Fusobacterium necrophorum. Neuropediatrics. 45(2):120-2, 2014
                                          19. Righini CA et al: Lemierre syndrome: study of 11 cases and literature review. Head Neck. 36(7):1044-51, 2014
                                          20. Blessing K et al: Lemierre syndrome associated with 12th cranial nerve palsy--a case report and review. Int J Pediatr Otorhinolaryngol. 77(9):1585-8, 2013
                                          21. Gutzeit A et al: Differential diagnosis of Lemierre's syndrome in a patient with acute paresis of the abducens and oculomotor nerves. Korean J Ophthalmol. 27(3):219-23, 2013
                                          22. Kim BY et al: Thrombophlebitis of the internal jugular vein (Lemierre syndrome): clinical and CT findings. Acta Radiol. 54(6):622-7, 2013
                                          23. Kizhner V et al: Methicillin-resistant Staphylococcus aureus bacteraemia associated with Lemierre's syndrome: case report and literature review. J Laryngol Otol. 127(7):721-3, 2013
                                          24. Ramos A et al: Diagnosis and treatment of Fusobacterium nucleatum discitis and vertebral osteomyelitis: case report and review of the literature. Spine (Phila Pa 1976). 38(2):E120-2, 2013
                                          25. Soh T et al: Lemierre's syndrome: an unusual cause of calf abscess. Ann Acad Med Singapore. 42(1):52-4, 2013
                                          26. Miller B et al: Lemierre syndrome causing bilateral cavernous sinus thrombosis. J Neuroophthalmol. 32(4):341-4, 2012
                                          27. Molloy A et al: The changing face of an old disease: case report of nonclassical Lemierre's syndrome caused by a Panton-Valentine leucocidin-positive methicillin-susceptible Staphylococcus aureus isolate. J Clin Microbiol. 50(9):3144-5, 2012
                                          28. Price K et al: A case of craniocervical abscess with sinus thrombosis in Lemierre's syndrome. Br J Neurosurg. 26(3):426-8, 2012
                                          29. Porquet-Bordes V et al: [Lemierre syndrome and influenza A (H1N1).] Arch Pediatr. 18(4):413-5, 2011
                                          30. Bonhoeffer J et al: Lemierre syndrome and nosocomial transmission of Fusobacterium necrophorum from patient to physician. Klin Padiatr. 222(7):464-6, 2010
                                          31. Chacko EM et al: Lemierre's and Lemierre's-like syndromes in association with infectious mononucleosis. J Laryngol Otol. 124(12):1257-62, 2010
                                          32. Deganello A et al: Necrotizing fasciitis of the neck associated with Lemierre syndrome. Acta Otorhinolaryngol Ital. 29(3):160-3, 2009
                                          33. Karkos PD et al: Lemierre's syndrome: a systematic review. Laryngoscope. 119(8):1552-9, 2009
                                          34. Monteiro MJ et al: Lemierre's syndrome: the changing face of a life-threatening infection. Br J Oral Maxillofac Surg. 47(8):648, 2009
                                          35. Rosado P et al: Lemierre's syndrome: a serious complication of an odontogenic infection. Med Oral Patol Oral Cir Bucal. 14(8):e398-401, 2009
                                          36. Hagelskjaer Kristensen L et al: Lemierre's syndrome and other disseminated Fusobacterium necrophorum infections in Denmark: a prospective epidemiological and clinical survey. Eur J Clin Microbiol Infect Dis. 27(9):779-89, 2008
                                          37. Brown LM et al: Lemierre's--the sinister sore throat. J Laryngol Otol. 121(7):692-4, 2007
                                          38. Chiu O et al: Lemierre's syndrome revisited: case report and imaging findings. Australas Radiol. 51 Suppl:B196-8, 2007
                                          39. Westhout F et al: Lemierre syndrome complicated by cavernous sinus thrombosis, the development of subdural empyemas, and internal carotid artery narrowing without cerebral infarction. Case report. J Neurosurg. 106(1 Suppl):53-6, 2007
                                          40. Jones C et al: Lemierre's syndrome presenting with peritonsillar abscess and VIth cranial nerve palsy. J Laryngol Otol. 120(6):502-4, 2006
                                          41. Gormus N et al: Lemierre's syndrome associated with septic pulmonary embolism: a case report. Ann Vasc Surg. 18(2):243-5, 2004
                                          42. De Sena S et al: Jugular thrombophlebitis complicating bacterial pharyngitis (Lemierre's syndrome). Pediatr Radiol. 26(2):141-4, 1996
                                          43. Goyal M et al: Unusual radiological manifestations of Lemierre's syndrome: a case report. Pediatr Radiol. 25 Suppl 1:S105-6, 1995
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Postanginal sepsis, necrobacillosis
                                                        • Also called "forgotten disease"
                                                      • Definitions

                                                        • Opportunistic infection causing septic thrombophlebitis & metastatic infection
                                                          • Complication of recent pharyngotonsillitis or other upper respiratory infection (sinus, ear)

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Ultrasonographic Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              • Image Interpretation Pearls

                                                                                • Reporting Tips

                                                                                  Selected References

                                                                                  1. Adedeji A et al: Anticoagulation strategies in the management of Lemierre syndrome: a systematic review of the literature. Ann Pharmacother. 1060028020957620, 2020
                                                                                  2. Gore MR: Lemierre syndrome: a meta-analysis. Int Arch Otorhinolaryngol. 24(3):e379-85, 2020
                                                                                  3. Howley F et al: Late presentation of 'Lemierre's syndrome': how a delay in seeking healthcare and reduced access to routine services resulted in widely disseminated Fusobacterium necrophorum infection during the global COVID-19 pandemic. BMJ Case Rep. 13(10), 2020
                                                                                  4. Moretti M et al: Lemierre's syndrome in adulthood, a case report and systematic review. Acta Clin Belg. 1-11, 2020
                                                                                  5. Nygren D et al: Invasive infections with Fusobacterium necrophorum including Lemierre's syndrome: an 8-year Swedish nationwide retrospective study. Clin Microbiol Infect. 26(8):1089.e7-9.e12, 2020
                                                                                  6. Repper DC et al: A case of Lemierre syndrome in the era of COVID-19: all that glitters is not gold. Pediatr Infect Dis J. 39(12):e445-7, 2020
                                                                                  7. Shires CB et al: Multiplanar computed tomography reconstruction to diagnose Lemierre's syndrome. OTO Open. 4(3):2473974X20940692, 2020
                                                                                  8. Ulanovski D et al: Medical and surgical characteristics of fusobacterium necrophorum mastoiditis in children. Int J Pediatr Otorhinolaryngol. 138:110324, 2020
                                                                                  9. Valerio L et al: Lemierre syndrome: Current evidence and rationale of the bacteria-associated thrombosis, Thrombophlebitis and LEmierre syndrome (BATTLE) registry. Thromb Res. 196:494-9, 2020
                                                                                  10. Valerio L et al: Patients with Lemierre syndrome have a high risk of new thromboembolic complications, clinical sequelae and death: an analysis of 712 cases. J Intern Med. 289(3):325-39., 2020
                                                                                  11. Davidoss N et al: Lemierre's syndrome - an unusual complication of otitis externa in a young, healthy female. J Laryngol Otol. 129 Suppl 1:S60-2, 2015
                                                                                  12. Hama Y et al: Slowly progressive Lemierre's syndrome with orbital pain and exophthalmos. J Infect Chemother. 22(1):58-60, 2015
                                                                                  13. Shiber J et al: Incomplete Lemierre syndrome. Pediatr Emerg Care. 31(1):39-41, 2015
                                                                                  14. Behpour-Oskooee M et al: Lemierre's syndrome with double heterozygote status in the methylenetetrahydrofolate reductase gene. World J Pediatr. 10(3):281-3, 2014
                                                                                  15. Cheng J et al: Fusobacterium necrophorum in a pediatric retropharyngeal abscess: A case report and review of the literature. Ear Nose Throat J. 93(12):E22-4, 2014
                                                                                  16. Gunatilake SS et al: Lemierre's syndrome secondary to community-acquired methicillin-resistant Staphylococcus aureus infection presenting with cardiac tamponade, a rare disease with a life-threatening presentation: a case report. Int J Emerg Med. 7:39, 2014
                                                                                  17. Gupta T et al: The forgotten disease: Bilateral lemierre's disease with mycotic aneurysm of the vertebral artery. Am J Case Rep. 15:230-4, 2014
                                                                                  18. Ratnasingham Y et al: Arterial ischemic stroke as a complication to disseminated infection with Fusobacterium necrophorum. Neuropediatrics. 45(2):120-2, 2014
                                                                                  19. Righini CA et al: Lemierre syndrome: study of 11 cases and literature review. Head Neck. 36(7):1044-51, 2014
                                                                                  20. Blessing K et al: Lemierre syndrome associated with 12th cranial nerve palsy--a case report and review. Int J Pediatr Otorhinolaryngol. 77(9):1585-8, 2013
                                                                                  21. Gutzeit A et al: Differential diagnosis of Lemierre's syndrome in a patient with acute paresis of the abducens and oculomotor nerves. Korean J Ophthalmol. 27(3):219-23, 2013
                                                                                  22. Kim BY et al: Thrombophlebitis of the internal jugular vein (Lemierre syndrome): clinical and CT findings. Acta Radiol. 54(6):622-7, 2013
                                                                                  23. Kizhner V et al: Methicillin-resistant Staphylococcus aureus bacteraemia associated with Lemierre's syndrome: case report and literature review. J Laryngol Otol. 127(7):721-3, 2013
                                                                                  24. Ramos A et al: Diagnosis and treatment of Fusobacterium nucleatum discitis and vertebral osteomyelitis: case report and review of the literature. Spine (Phila Pa 1976). 38(2):E120-2, 2013
                                                                                  25. Soh T et al: Lemierre's syndrome: an unusual cause of calf abscess. Ann Acad Med Singapore. 42(1):52-4, 2013
                                                                                  26. Miller B et al: Lemierre syndrome causing bilateral cavernous sinus thrombosis. J Neuroophthalmol. 32(4):341-4, 2012
                                                                                  27. Molloy A et al: The changing face of an old disease: case report of nonclassical Lemierre's syndrome caused by a Panton-Valentine leucocidin-positive methicillin-susceptible Staphylococcus aureus isolate. J Clin Microbiol. 50(9):3144-5, 2012
                                                                                  28. Price K et al: A case of craniocervical abscess with sinus thrombosis in Lemierre's syndrome. Br J Neurosurg. 26(3):426-8, 2012
                                                                                  29. Porquet-Bordes V et al: [Lemierre syndrome and influenza A (H1N1).] Arch Pediatr. 18(4):413-5, 2011
                                                                                  30. Bonhoeffer J et al: Lemierre syndrome and nosocomial transmission of Fusobacterium necrophorum from patient to physician. Klin Padiatr. 222(7):464-6, 2010
                                                                                  31. Chacko EM et al: Lemierre's and Lemierre's-like syndromes in association with infectious mononucleosis. J Laryngol Otol. 124(12):1257-62, 2010
                                                                                  32. Deganello A et al: Necrotizing fasciitis of the neck associated with Lemierre syndrome. Acta Otorhinolaryngol Ital. 29(3):160-3, 2009
                                                                                  33. Karkos PD et al: Lemierre's syndrome: a systematic review. Laryngoscope. 119(8):1552-9, 2009
                                                                                  34. Monteiro MJ et al: Lemierre's syndrome: the changing face of a life-threatening infection. Br J Oral Maxillofac Surg. 47(8):648, 2009
                                                                                  35. Rosado P et al: Lemierre's syndrome: a serious complication of an odontogenic infection. Med Oral Patol Oral Cir Bucal. 14(8):e398-401, 2009
                                                                                  36. Hagelskjaer Kristensen L et al: Lemierre's syndrome and other disseminated Fusobacterium necrophorum infections in Denmark: a prospective epidemiological and clinical survey. Eur J Clin Microbiol Infect Dis. 27(9):779-89, 2008
                                                                                  37. Brown LM et al: Lemierre's--the sinister sore throat. J Laryngol Otol. 121(7):692-4, 2007
                                                                                  38. Chiu O et al: Lemierre's syndrome revisited: case report and imaging findings. Australas Radiol. 51 Suppl:B196-8, 2007
                                                                                  39. Westhout F et al: Lemierre syndrome complicated by cavernous sinus thrombosis, the development of subdural empyemas, and internal carotid artery narrowing without cerebral infarction. Case report. J Neurosurg. 106(1 Suppl):53-6, 2007
                                                                                  40. Jones C et al: Lemierre's syndrome presenting with peritonsillar abscess and VIth cranial nerve palsy. J Laryngol Otol. 120(6):502-4, 2006
                                                                                  41. Gormus N et al: Lemierre's syndrome associated with septic pulmonary embolism: a case report. Ann Vasc Surg. 18(2):243-5, 2004
                                                                                  42. De Sena S et al: Jugular thrombophlebitis complicating bacterial pharyngitis (Lemierre's syndrome). Pediatr Radiol. 26(2):141-4, 1996
                                                                                  43. Goyal M et al: Unusual radiological manifestations of Lemierre's syndrome: a case report. Pediatr Radiol. 25 Suppl 1:S105-6, 1995