Lemierre's syndrome leading to cerebral venous thrombosis

Síndrome de Lemierre como causa de trombose venosa cerebral

A febrile 53-year-old man presented with a severe headache one month post-esophagectomy. Inspection highlighted inflammatory signs in the neck incision. Neurological examination was normal. Cerebrospinal fluid demonstrated increased protein levels (155 mg/dL) and mild pleocytosis (11 cells/mm³) with negative bacterial and fungi cultures. Blood cultures were positive for Streptococcus mitis. Vascular imaging of the head and neck revealed a central venous thrombosis, which together with the laboratory findings, matched the characteristics of Lemierre's syndrome (Figure). Lemierre's syndrome is a thrombophlebitis of the internal jugular vein¹ commonly related to an infection². The patient had a good outcome after antibiotic and oral anticoagulant treatment.

Figure
A/B: Sagittal (A) and coronal (B) contrast enhanced computed tomography of the neck revealing thickened and enhanced walls with filling defects in the left internal jugular vein (consistent with thrombosis). It is also possible to note air bubbles inside this vein (arrows). C/D: Axial T1-weighted images after contrast also showing filling defects (arrowheads) in the left transverse sinus (C) and in the superior sagittal sinus (D) compatible with cerebral venous thrombosis.

• Support: Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) (Grant #13/01766-7 and #2014/19786-7), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).

References

• ¹
  Kim BY, Yoon DY, Kim HC, Kim ES, Baek S, Lim KJ et al. Thrombophlebitis of the internal jugular vein (Lemierre syndrome): clinical and CT findings. Acta Radiol. 2013 Nov;54(6):622-7. https://doi.org/10.1177/0284185113481019
  » https://doi.org/10.1177/0284185113481019
• ²
  Farhan A, Shah YA, Ali BT, Mumtaz U, Farooq U. The forgotten disease: Lemierre's syndrome. J Pak Med Assoc. 2016;66(12):1652-5.

Publication Dates

• Publication in this collection
  May 2018

History

• Received
  02 Jan 2018
• Reviewed
  17 Jan 2018
• Accepted
  03 Feb 2018