The New England Journal of MedicineLemierre’s Syndrome Complicated by Cavernous Sinus Thrombosis

Rare Complication of Lemierre’s Syndrome Highlights Potential Link Between Respiratory Infections and Neurological Manifestations

A case report details a 20-year-old woman diagnosed with Lemierre’s syndrome, complicated by cavernous sinus thrombosis and oculomotor nerve palsy. The patient, initially diagnosed with influenza, presented with headache, double vision, and right eyelid drooping. Imaging revealed bilateral cavernous sinus thrombosis, internal jugular vein thrombi, and Fusobacterium necrophorum in blood cultures. The case serves as a reminder for physicians to consider rare but severe complications in patients with recent respiratory infections.

Key Points:

• Patient: 20-year-old woman with recent influenza diagnosis
• Presenting symptoms: 1-week history of headache, 1-day history of double vision and right eyelid drooping
• Physical examination: Right eyelid ptosis, depressed and abducted right eye with large, nonreactive pupil
• Diagnosis: Lemierre’s syndrome with cavernous sinus thrombosis and oculomotor nerve palsy
• Imaging findings:
  • Contrast-enhanced MRI: Bilateral cavernous sinus thrombosis, right oculomotor nerve compression
  • CT venography: Thrombi in both internal jugular veins
• Blood culture: Positive for Fusobacterium necrophorum
• Treatment: Antimicrobial agents and oral anticoagulation
• Follow-up at 2 months:
  • Ptosis resolved, diplopia persisted
  • Imaging showed resolution of all thromboses
• No signs of septic emboli on chest imaging

This case highlights the importance of maintaining a high index of suspicion for Lemierre’s syndrome in young adults presenting with neurological symptoms following respiratory infections. Early diagnosis and appropriate management, including antimicrobial therapy and anticoagulation, are crucial for improving outcomes and preventing long-term complications.

Image Credit: emDOCs.net

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