Lemierre's Syndrome: Case Report Of 'The Forgotten Disease' In Current Covid-19 Pandemic

ABSTRACT

Introduction Lemierre's syndrome (LS) refers to infectious thrombophlebitis of the internal jugular vein (IJV) developed as a complication of an oropharyngeal infection. It is a serious condition which may lead to septicemia and septic embolization. LS is most frequently caused by the anaerobic Fusobacterium necrophorum. In the current post-antibiotic era, it is rare (annual incidence of 0.8 cases/million). Many clinicians are unaware of LS, leading it to be termed "the forgotten disease." Signs and symptoms include odynophagia, fever and easy fatigue simulating, among others, infection by COVID-19. Broad spectrum antibiotherapy should be started promptly. If a deep abscess is present, drainage is indicated. In cases of persistent sepsis or embolization, surgical ligation/excision of the IJV may be considered. Currently, the most controversial role in LS management is anticoagulation. Compared with pre-antibiotic era mortality has much improved (0-18%). Since 2004 there are only four cases of LS reported in Portugal (Medline).