Minerva: Lemierre's syndrome in elderly woman

A 62 year old woman presented with fever, sore throat, and painful swelling along the left sternomastoid muscle. Blood cultures consistently isolated group A streptococcus. Magnetic resonance imaging showed left internal jugular thrombophlebitis (arrow head). Septic thrombophlebitis of the internal jugular vein arising from oropharyngeal infection (Lemierre’s syndrome) frequently leads to potentially fatal metastatic abscesses in the lungs, bones, joints, skin, and soft tissues. The most common pathogen is Fusobacterium necrophorum, an anaerobic oropharyngeal commensal of healthy young adults. Lemierre’s syndrome is a rare complication of streptococcal pharyngitis. Early recognition and treatment with antibiotics in our patient led to an uneventful recovery without metastatic sequelae.