Lemierre Syndrome Following Dental Extraction: A Case Report.

Lemierre syndrome is a rare but potentially life-threatening condition characterized by septic thrombophlebitis of the internal jugular vein and hematogenous dissemination of septic emboli. Although classically associated with oropharyngeal infections, atypical presentations from odontogenic sources are increasingly recognized and may complicate early diagnosis. We report the case of a 29-year-old male patient who developed Lemierre syndrome following lower third molar extraction. He presented with right cervical swelling, dysphonia, odynophagia, and cough. Laboratory findings showed leukocytosis with neutrophilia. Imaging studies revealed a deep cervical collection consistent with Ludwig's angina, extensive thrombosis of the right internal jugular vein with extension to the jugular bulb, sigmoid sinus, and subclavian vein, and multiple bilateral pulmonary lesions suggestive of septic emboli. The patient underwent surgical drainage and received broad-spectrum antibiotic therapy along with anticoagulation due to the extent of thrombosis. Microbiological cultures were negative, likely influenced by prior antibiotic exposure and the inherent difficulty in isolating anaerobic pathogens such as Fusobacterium species. Despite significant radiological involvement, clinical evolution was favorable, without hemodynamic instability or respiratory compromise. Follow-up demonstrated a reduction of pulmonary lesions and eventual resolution of thrombosis. This case highlights an uncommon odontogenic origin with unusually extensive venous propagation, including intracranial extension, in the setting of a relatively benign systemic course. It underscores the importance of considering Lemierre syndrome in deep cervicofacial infections after dental procedures, even in the absence of a preceding pharyngeal infection, and reinforces the need for early imaging and multidisciplinary management to enable timely diagnosis and appropriate treatment.