Excision of the internal jugular vein in uncontrolled Lemierre's syndrome: a case report and literature review.

BACKGROUND

Lemierre's syndrome is a rare condition characterized by head and neck infection, septic thrombophlebitis of the internal jugular vein (IJV), bacteremia, and septic embolic complications. Although the classic form is usually associated with oropharyngeal infection and Fusobacterium necrophorum, odontogenic and non-Fusobacterium cases have also been reported. Most cases are controlled with source control and prolonged antimicrobial therapy, with or without anticoagulation.

CASE REPORT: We report a severe case of Lemierre's syndrome following odontogenic infection in a 64-year-old man. Contrast-enhanced computed tomography revealed a deep neck space abscess and right IJV thrombosis. Cultures grew viridans group streptococci. Despite drainage, repeated irrigation, broad-spectrum antimicrobial therapy, and anticoagulation, the patient developed persistent bacteremia, septic pulmonary complications, disseminated intravascular coagulation, and acute respiratory distress syndrome. Surgical excision of the thrombosed IJV was performed as salvage treatment after multidisciplinary reassessment. Blood cultures became negative on the day following IJV excision, and the patient subsequently improved after prolonged intensive treatment.

CONCLUSION

IJV excision remains controversial and should not be considered routine treatment for Lemierre's syndrome. However, it may be considered as a salvage option in carefully selected patients with persistent septicemia, progressive septic embolization, or clinical deterioration despite adequate source control, appropriate antimicrobial therapy, and multidisciplinary management.