Lemierre’s syndrome in adulthood, a case report and systematic review

ABSTRACT

Introduction: Lemierre’s syndrome is a septic thromboembolic complication of an oropharyngeal or neck infection, primarily caused by Fusobacterium species. Although it usually affects young healthy patients, some case reports describe this syndrome in older population.

Methods: A case report and a systematic review of the literature were conducted to investigate the late onset of Lemierre’s syndrome. Forty-one articles were selected for the qualitative analysis, 39 for the quantitative analysis.

Results: The average age of the study population was 52 years old. Diabetes mellitus and upper gastro-intestinal malignancy, common comorbidities in the study population, might play a role in the development of late-onset Lemierre’s syndrome. Empiric antibiotic treatment should cover Fusobacterium and Streptococcus species both, which may cooperate to induce purulent disease. Reported unfavourable outcome was more than expected.

Conclusion: Lemierre’s syndrome in adulthood may differ from the usual version. This disease may further pass unrecognized, if presented out of the expected age range. Nevertheless, early diagnosis and prompt treatment are a requisite to prevent morbidity and mortality, which may be higher in this older population.

KEYWORDS:

• Infectious disease
• Lemierre’s syndrome
• internal jugular vein thrombosis
• Fusobacterium necrophorum
• Lancefield group F Streptococcus

Disclosure statement

The author reports no conflicts of interest in this work.