Lemierre's syndrome is a possible complication of a severe, untreated throat or tonsil infection. It is most commonly seen in otherwise healthy adolescents and young adults. Problems occur when bacteria begin to thrive within abscesses in the throat, leading to deep infections that may reach a major blood vessel called the jugular vein. If the vein is compromised, it can lead to dangerous blood clotting and tissue death in the respiratory tract. Most cases of Lemierre's syndrome can be cured with antibiotics if the condition is discovered and treated right away.
Several different types of bacteria can lead to Lemierre's syndrome, but the most common culprit is Fusobacterium necrophorum (F. necrophorum). Bacteria attach to the walls of the pharynx and eventually create an abscess. F. necrophorum that reach the jugular vein trigger a clotting response that severely limits blood flow from the head back to the heart. As the clot naturally starts to break apart, infected blood travels to the lungs and throughout the body.
The first symptoms of Lemierre's syndrome typically include a worsening sore throat, a mild fever, and tenderness in the front and side of the neck. Flu-like symptoms of joint pain and fatigue may set in as an infection starts to spread. Clotting can lead to extreme weakness, light-headedness, and fainting. Shallow breathing and a slowed heart rate are signs that infection has reached the lungs.
A doctor can diagnose Lemierre's syndrome by reviewing symptoms, taking diagnostic imaging scans of the neck, and analyzing lab results of blood tests. Computerized tomography scans and ultrasounds of the neck reveal extensive inflammation of the pharynx and blood clotting in the jugular vein. If infection has spread to the lungs or lymph nodes, imaging tests can be used to gauge the extent of damage. Blood cultures that are positive for F. necrophorum help to confirm the diagnosis. Patients are generally hospitalized so doctors can monitor changes in their symptoms and determine the best course of treatment.
Treatment for Lemierre's syndrome depends on the severity of the infection. Many cases can be managed with a long course of intravenous antibiotics. Blood thinners may also be given to break up existing clots and reduce the risk of future obstructions. If the jugular vein is severely damaged, it may need to be removed or bypassed using a transplanted large blood vessel. Other surgeries or clinical procedures may be considered in the case of a spreading infection. Most patients who receive treatment in the early stages of Lemierre's syndrome are able to make full recoveries in about two months.
