Un imprevisto tra capo e collo: la sindrome di Lemierre

A healthy 15-year-old boy was hospitalized due to the persistence of lateral cervical swelling associated with fever and worsening of headache. He underwent a neck and facial mass CT scan showing a thrombophlebitis of the internal jugular vein extended to the intracranial sinuses. The diagnosis of Lemierre syndrome (LS) was formalized with positive blood colture for Fusobacterium necrophorum. Intravenous antibiotic therapy associated with anticoagulant therapy was started with complete clinical recovery after 4 weeks of treatment. A close clinical-instrumental follow-up was set up. Lemierre syndrome is a thrombophlebitis of the internal jugular vein, that in this case was extended to the intracranial sinuses. It is a rare condition, secondary to the extension of an infectious process starting from the oropharynx. The clinical picture is characterized by high fever, persistent pharyngitis followed by sepsis, pneumo-nia or atypical laterocervical pain. Fusobacterium necrophorum, a gram-negative anaerobe bacteriu,, is the responsible pathogen in most of the cases (>90%). The antibiotic treatment is prolonged (at least 4-6 weeks); occasionally a parallel surgical approach is necessary. The start of anticoagulant thera-py for internal venous thrombosis associated with LS is still matter of debate.