Lemierre’s Syndrome With Cavernous Sinus Thrombosis: A Life-Threatening Complication of Peritonsillar Abscess

Abstract

Introduction: Lemierre’s syndrome is a rare and life-threatening form of septic thrombophlebitis that can complicate head and neck infections. In most cases, septic thrombophlebitis affects the internal jugular vein. Its extension into the cerebral venous sinus is extremely rare, especially in the cavernous sinus. Herein, we report a rare and fatal case of peritonsillar phlegmon complicated by extensive cervicofacial fasciitis, with both internal jugular vein and cavernous sinus thrombophlebitis. Observation: It was a 72-year-old patient with a history of type II diabetes and chronic renal failure. He presented with painful right swelling of the neck and face, fever, and dyspnea. Physical examination revealed a conscious patient with right inflammatory cervicofacial swelling, trismus, and para-pharyngeal bulging. Contrast-enhanced computed tomography revealed extensive right cervicofacial fasciitis, thrombosis of the ipsilateral internal jugular vein and transversal sinus. He received intravenous antibiotic therapy, surgical drainage, and monitoring in the intensive care unit with mechanical ventilation. However, evolution was pejorative. He presented a right cavernous sinus thrombosis, then septic shock and died 4 days after admission. Conclusion: Oropharyngeal infections must be properly and promptly managed, as they carry the risk of leading to severe, potentially life-threatening complications, such as Lemierre’s syndrome. Lemierre’s syndrome prognosis is particularly worsened by the extension to intracranial sinuses. A rapid diagnosis remains the best guarantee for optimizing patient management.