Lemierre’s Syndrome: an atypical presentation

Abstract Septic thrombophlebitis is a rare diagnosis in this era of widespread antibiotic usage. The clinical diagnosis requires astute clinical suspicion and evaluation. We describe an asplenic 63-year-old woman who presented to the Emergency department with a 24-hour history of a tender, swollen, right neck and upper chest wall. She denied any recent illnesses, but two years prior she was hospitalized and treated for Streptococcus pneumoniae meningitis and endocarditis. An enhanced CT scan demonstrated inflammatory changes around a thrombosed right internal jugular vein, which extended to the brachiocephalic/SVC junction. A retropharyngeal effusion was present, but no pulmonary or oropharyngeal abscess was identified. Lemierre’s syndrome, although rare, must be recognized promptly to reduce morbidity and mortality associated with this condition.