Lemierre's syndrome: Review of the English literature over the past 25 years

Lemierre's syndrome is a rare disorder characterized by pharyngitis, tonsillar and/or jugular vein thrombophlebitis, and septicemia usually caused by the anaerobic bacteria Fusobacterium necrophorum. Over the past 25 years, 85 cases of Lemierre's syndrome have been reported in the English literature. Unusual presentations such as meningitis, septic joints, and soft tissue abscesses may occur in addition to the classic syndrome of jugular vein thrombophlebitis and septic pulmonary emboli. Other pulmonary complications reported with this syndrome include frank lung abscesses, parapneumonic pleural effusions, empyema, acute respiratory distress syndrome, and diffuse alveolar hemorrhage. Empyema was found in 23% (14/61) of the evaluable cases. We report a man with Lemierre's syndrome, who, at 45 years of age, is significantly older than the 85 patients previously reported. Although less common now in the antibiotic era, there recently have been several reports of Lemierre's syndrome. Clinicians should be aware of this uncommon infection and its presentation, because late recognition may lead to poor outcome.