From the Research
Lemierre's syndrome is a rare and potentially life-threatening complication of oropharyngeal infections, characterized by septic thrombophlebitis of the internal jugular vein and septic emboli, which requires prompt diagnosis and treatment with broad-spectrum antibiotics and anticoagulation therapy in selected cases. The condition typically affects healthy adolescents and young adults, with a mean age of presentation around 20 years old 1. The diagnosis of Lemierre's syndrome can be challenging, but it is essential to suspect it in patients with prolonged pharyngitis followed by unilateral neck swelling and fevers 1. The mainstay of treatment is antibiotic therapy, combining a third-generation cephalosporin or a betalactam with metronidazole, and anticoagulant therapy should be reserved for high-risk situations related to thrombosis 2. Some studies suggest that anticoagulation should be carried out in the absence of any contraindication or presumed risk, following clinical anticoagulation guidelines, and only in patients with poor clinical response despite antibiotics therapy, predisposing thrombophilia, and intracranial thrombosis 3. Key points to consider in the management of Lemierre's syndrome include:
- Prompt diagnosis and treatment to prevent significant morbidity and mortality
- Broad-spectrum antibiotics as the mainstay of treatment
- Anticoagulation therapy in selected cases
- Surgical treatment may be required in case of peripheral septic lesions
- The role of anticoagulation is controversial, and its use should be individualized based on the patient's risk factors and clinical response to treatment 4. It is crucial to be aware of Lemierre's syndrome and its potential complications to provide timely and effective management, as delayed treatment can lead to disastrous outcomes 1.