Please see also Links To And Excerpts From “Lemierre’s Syndrome: Recognising a Typical Presentation of a Rare Condition”
Posted on October 28, 2019 by Tom Wade MD
Here are the show notes for this section of the podcast:
Lemierre’s Syndrome Clinical Clues
- Lemierre’s syndrome is a rare, life-threatening diagnosis most commonly seen in children and young adults. It is thrombophlebitis of the internal jugular vein with bacteremia, often fusobacterium.
- Patients will frequently be toxic at the time of diagnosis and can have “metastatic” lesions from septic emboli – pneumonia, meningitis, bacteremia, septic joints etc. as well as cranial nerve abnormalities
- Consider the diagnosis in patients with prolonged pharyngitis (>7 days), a history of pharyngitis that improves and then worsens, septic patients with pharyngitis, those with pharyngitis and a second infection (pharyngitis “+1”), and those with signs of deep space infection such as trismus, pain on rotation of the neck, or palpable neck mass.
- Diagnosis is typically made by CT of the neck with contrast.
- Treatment is with broad spectrum antibiotics such as peperacillin-tazobactam or ampicillin-sulbactam usually in the ICU.
- Treatment of all patients with simple pharyngitis with antibiotics does not prevent the development of Lemierre’s.
Podcast production, editing and sound design by Anton Helman
Podcast content & blog post by Anand Swaminathan, Brit Long, Emily Austin & Sucheta Sinha, edited by Anton Helman
Topics in this EM Quick Hits podcast
Anand Swaminathan on Lemierre’s syndrome (0:33)
Emily Austin on clonidine toxicity (06:20)
Brit Long on myths of routine coagulation panel testing (11:48)
Hans Rosenberg and Michael Ho on reversal of anticoagulation (17:22) *
Sheldon Cheskes on mechanical CPR (24:00)
*CJEM collaboration quick hit, reviewing ‘Just the Facts’ series