Sore Throat and Neck Swelling

Mukarram O, Memon S, Ahmed Y

July 24, 2015

A 22 year-old male college student presented with fever, cough, and neck pain. Physical examination revealed a temperature of 102oF, pulse of 130 beats/min, respiratory rate of 28 breaths/min, and oxygen saturation of 92% on room air. Oral examination showed pharyngeal erythema, enlarged erythematous tonsils (right more than left) without exudates, and tender right submandibular lymphadenopathy with ipsilateral diffuse soft tissue swelling in the lateral neck. Lab work showed an elevated white blood count of 15.6 x 103/ µL (80% neutrophils) and blood cultures grew Group C Streptococcus and Prevotella Disiens. CT scan of the neck showed right internal jugular vein (IJV) thrombosis (Image A and B) with extension almost to the cavernous sinus suggesting Lemierre’s syndrome (LS). Images C and D show resolution of the swelling with shriveling of the IJV after 6 weeks of IV piperacillin/tazobactam and warfarin. 

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References:

1. Peter D. Karkos, Sheetal Asrani et al, Lemierre’s Syndrome: A Systematic Review. 119: August 2009 The Laryngoscope
2. Elzubeir A, Elzubeir S, Szuszman A, Petkova D, Fletcher T; Lemierre’s Syndrome: Forgotten Disease? Clinical Microbiology 4:1, 2015


Author Biography

Osama Mukarram, MD received his MBBS from Shifa College of Medicine in Pakistan in 2012 and is currently an internal medicine resident at Texas Tech University Health Sciences Center at the Permian Basin.