Lemierre's syndrome secondary to fusobacterium necrophorum in an immunocompetent patient: A rare case

Abstract

Lemierre syndrome is a rare and life-threatening condition that typically arises secondary to an oropharyngeal infection, progressing to thrombosis of the internal jugular vein and dissemination of septic emboli, most commonly to the lungs. Diagnosis is confirmed via contrast-enhanced cervicothoracic CT imaging, which identifies the presence of internal jugular vein thrombosis. Immediate treatment involves broad-spectrum antibiotic therapy, often utilizing a third-generation cephalosporin or a beta-lactam in combination with metronidazole. In select high-risk cases, anticoagulation may be warranted, and surgical intervention may be indicated in severe presentations. The prognosis hinges critically on the promptness of diagnosis and management, as untreated cases are associated with a significantly elevated mortality risk. We report the case of a 13-year-old girl with no significant medical history, who presented to the emergency department with perioral edema, necrotic lesions with signs of inflammation, right cervical swelling, fever, and progressive deterioration of her general condition in the context of a dental abscess. Clinical, laboratory, and imaging investigations confirmed the diagnosis of Lemierre's syndrome. Given the rarity of this condition, maintaining a high level of clinical suspicion is essential to prevent misdiagnosis and delays in initiating appropriate management, which are critical for ensuring optimal patient outcomes.