Abstract

SANCHEZ ACEDO, Celia et al. Thrombosis of the internal jugular vein and descending necrotizing mediastinitis due to acute pharyngotonsilitis. Rev Esp Cirug Oral y Maxilofac [online]. 2010, vol.32, n.3, pp.119-122. ISSN 2173-9161.

Lemierre syndrome is a potentially fatal condition after an oropharyngeal infection. It is characterized by thrombophlebitis of head and neck veins with systemic dissemination of septic emboli. The diagnosis of this syndrome is mainly clinical and complementary test only serve as aid to confirm it. We report an unusual case of Lemierre syndrome in a 31-year-old man caused by Gemella spp. and Streptococcus pyogenes. It developed following a pharyngotonsillitis infection, which deteriorated rapidly and progressively despite intravenous antibiotic treatment. He finally had to be intervened due to developing acute descending necrotizing mediastinitis from the pre-thyroid region to the diaphragm, with thrombosis of the internal jugular vein. An urgent thoracotomy and left cervicotomy was performed, with drainage of abundant purulent material and ligature of the internal jugular vein. We also discuss its atypical clinical presentation, the crucial role of imaging in the early diagnosis, and the different treatment options of this life-threatening syndrome.

Keywords : Lemierre syndrome; Thrombosis of the internal jugular vein; Descending necrotizing mediastinitis.

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