{"title":"Lemierre's Syndrome: An Unlikely Diagnosis in a Patient Presenting with Diarrhoea and Vomiting, or Maybe not?","authors":"Giorgos Papaleontiou, Adam Young","doi":"10.12890/2025_005063","DOIUrl":null,"url":null,"abstract":"<p><p>Lemierre's syndrome is an infectious thrombophlebitis of the internal jugular vein (IJV) where the commonest causative agent is a <i>Fusobacterium</i> from a tonsillar or peritonsillar abscess. This is a case presentation of a patient whose primary complaint was diarrhoea. The blood cultures of this patient grew a <i>Fusobacterium necrophorum</i> which prompted imaging. The imaging demonstrated a right peritonsillar abscess and IJV thrombosis with septic emboli in the lungs. Key points highlighted are: 1) blood cultures remain a key investigation in making a diagnosis in the septic patient; 2) abdominal symptoms can be part of Lemierre's syndrome; 3) abdominal symptoms (abdominal pain, vomiting and diarrhoea) have been characterised as the third, fourth and fifth most common feature after fever and dyspnoea. This case is presented because it shows how Lemierre's syndrome can present with abdominal features, and this may be incongruent with clinicians' understanding and teaching.</p><p><strong>Learning points: </strong>Lemierre's syndrome is an infectious thrombophlebitis of the internal jugular vein most commonly due to <i>Fusobacterium necrophorum</i> originating from a tonsillar or peritonsillar abscess, which may cause septic emboli in the lungs.Gastrointestinal symptoms, including diarrhoea, are commoner than appreciated or classically taught in this syndrome.Blood cultures are a key investigation in the septic patient and in those that grow a Gram-negative rod, <i>Fusobacterium</i> should be considered, and suspicions of Lemierre's syndrome should be raised.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005063"},"PeriodicalIF":0.0000,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061219/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European journal of case reports in internal medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.12890/2025_005063","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Lemierre's syndrome is an infectious thrombophlebitis of the internal jugular vein (IJV) where the commonest causative agent is a Fusobacterium from a tonsillar or peritonsillar abscess. This is a case presentation of a patient whose primary complaint was diarrhoea. The blood cultures of this patient grew a Fusobacterium necrophorum which prompted imaging. The imaging demonstrated a right peritonsillar abscess and IJV thrombosis with septic emboli in the lungs. Key points highlighted are: 1) blood cultures remain a key investigation in making a diagnosis in the septic patient; 2) abdominal symptoms can be part of Lemierre's syndrome; 3) abdominal symptoms (abdominal pain, vomiting and diarrhoea) have been characterised as the third, fourth and fifth most common feature after fever and dyspnoea. This case is presented because it shows how Lemierre's syndrome can present with abdominal features, and this may be incongruent with clinicians' understanding and teaching.
Learning points: Lemierre's syndrome is an infectious thrombophlebitis of the internal jugular vein most commonly due to Fusobacterium necrophorum originating from a tonsillar or peritonsillar abscess, which may cause septic emboli in the lungs.Gastrointestinal symptoms, including diarrhoea, are commoner than appreciated or classically taught in this syndrome.Blood cultures are a key investigation in the septic patient and in those that grow a Gram-negative rod, Fusobacterium should be considered, and suspicions of Lemierre's syndrome should be raised.
期刊介绍:
The European Journal of Case Reports in Internal Medicine is an official journal of the European Federation of Internal Medicine (EFIM), representing 35 national societies from 33 European countries. The Journal''s mission is to promote the best medical practice and innovation in the field of acute and general medicine. It also provides a forum for internal medicine doctors where they can share new approaches with the aim of improving diagnostic and clinical skills in this field. EJCRIM welcomes high-quality case reports describing unusual or complex cases that an internist may encounter in everyday practice. The cases should either demonstrate the appropriateness of a diagnostic/therapeutic approach, describe a new procedure or maneuver, or show unusual manifestations of a disease or unexpected reactions. The Journal only accepts and publishes those case reports whose learning points provide new insight and/or contribute to advancing medical knowledge both in terms of diagnostics and therapeutic approaches. Case reports of medical errors, therefore, are also welcome as long as they provide innovative measures on how to prevent them in the current practice (Instructive Errors). The Journal may also consider brief and reasoned reports on issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to the scientific meetings of acknowledged medical societies.