Lemierre’s Syndrome

Yesterday we discussed the case of a young man with no past medical history who presented with subacute onset progressive unilateral facial swelling and B symptoms unresponsive to oral antibiotics

Our differential diagnosis included infectious etiologies (bacterial abscess, EBV, Mumps, TB lymphadenitis), malignancy (lymphoma, squamous cell carcinoma, Burkhitt’s lymphoma), and Lemierre’s syndrome (thrombophlebitis of IJ).

On CT Neck, patient was found to have multiple mandibular abscesses, and apical lung cavitary lesions concerning for septic emboli. While neck ultrasound did not find a thrombus within the internal jugular vein, given cavitary lesions in the lungs, Lemierre’s syndrome was thought to have been the diagnosis.

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