Lemmiere's syndrome following infectious mononucleosis.

Postanginal septicemia, or Lemmiere’s syndrome, was Treatment was begun with intravenous amoxicillin/clavfirst described in 1936 [1]. It is characterized by acute oropharyngeal infection complicated by septic thrombophlebitis and/or metastatic infections that usually involve the lungs. The pathogen most often isolated is Fusobacterium necroforum. Although the occurrence of this entity in young patients has been described in numerous reports [2], in only a few instances has it been associated with infectious mononucleosis [3,4]. A previously healthy 26-year-old woman presented to our emergency department with fever, a tender swelling in the right supraclavicular area and slight abdominal pain. On admission her temperature was 38.7 jC, her pulse was 80 beats/min, and her blood pressure 120/75 mm Hg. On examination, she had erythema of her oropharynx and a right supraclavicular mass. Her lungs were clear and there was no cervical lymphadenopathy. Although she had diffuse abdominal tenderness, her bowel sounds were active. There was mild anemia (Hb: 9.7 g/dl) and an elevated white blood cell count (WBC: 16.900/Al with 85% segmented neutrophils and 6% atypical monocytes), yet her platelet count and prothrombin time were normal. Her ESR, C-reactive protein, alanine aminotransferase, and aspartate aminotransferase were elevated. Her monospot was positive, and the diagnosis of infectious mononucleosis was confirmed by the presence of IgM and IgG antibodies to capsid EBV antigen and the subsequent demonstration of rising IgG antibody titers. Enlarged right supraclavicular lymph nodes with necrosis, but without thrombosis of the ipsilateral internal jugular vein, were demonstrated using both ultrasound and contrast enhanced CT of the neck and chest. CT also showed pleural thickening in the right lung.