From the Research
Lemierre's syndrome is a rare and severe medical condition characterized by sepsis, internal jugular vein thrombosis, and metastatic septic emboli, typically caused by Fusobacterium necrophorum or other bacteria, and requires prompt diagnosis and treatment to prevent high morbidity and mortality. The diagnosis of Lemierre's syndrome can be challenging, but it is essential to confirm it precociously with cervicothoracic CT-scan, reference exam, and bacteriological examinations 1. The management of Lemierre's syndrome consists of emergency antibiotic treatment, combining a third-generation cephalosporin or a betalactam with metronidazole, and anticoagulant therapy to be reserved for high-risk situations related to thrombosis 1. 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 2. Key points to consider in the treatment of Lemierre's syndrome include:
- Prompt initiation of antibiotic therapy
- Use of anticoagulant therapy in selected cases
- Surgical treatment may be required in some cases
- Regular follow-up to monitor response to therapy The most recent and highest quality study on Lemierre's syndrome, published in 2024, highlights the importance of timely diagnosis and treatment to prevent complications and improve outcomes 3. In summary, the treatment of Lemierre's syndrome should prioritize prompt antibiotic therapy, with anticoagulant therapy and surgical treatment considered on a case-by-case basis, to minimize morbidity and mortality. It is crucial to be aware of the potential severity of Lemierre's syndrome and to consider it in the differential diagnosis of patients presenting with symptoms of sepsis, thrombosis, or metastatic infection 4. Overall, the management of Lemierre's syndrome requires a comprehensive approach, taking into account the latest evidence and guidelines, to ensure the best possible outcomes for patients.