Question:
A 16-year-old boy develops sore throat followed by high fever and rigors. After a week, he presents with septicemia and neck pain. Imaging reveals thrombosis of the internal jugular vein. This clinical scenario is most consistent with:
A 16-year-old boy develops sore throat followed by high fever and rigors. After a week, he presents with septicemia and neck pain. Imaging reveals thrombosis of the internal jugular vein. This clinical scenario is most consistent with:
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Classic triad of Lemierre's syndrome: Antecedent pharyngitis + Internal jugular vein thrombophlebitis + Metastatic septic pulmonary emboli (Causative agent: Fusobacterium necrophorum).
Updated On: Sep 3, 2026
- Thrombosis of IJV following oropharyngeal infection
- Acute inflammation of submandibular space causing airway obstruction
- Thrombosis of cerebral venous sinuses due to meningitis
- Bacterial endocarditis following pharyngitis
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The Correct Option is A
Solution and Explanation
Concept:
Lemierre's syndrome (post-anginal septicemia) is a severe, potentially fatal complication of acute bacterial pharyngitis/tonsillitis seen predominantly in healthy adolescents and young adults.
It is classically characterized by an antecedent oropharyngeal infection leading to secondary septic thrombophlebitis of the internal jugular vein (IJV) and disseminated septic embolization.
Explanation:
• The primary causative organism in the vast majority of cases is Fusobacterium necrophorum, an obligate anaerobic, gram-negative bacillus that is part of the normal oral flora.
• The disease begins as a primary oropharyngeal infection (pharyngitis, peritonsillar abscess, or tonsillitis) that invades the lateral pharyngeal (parapharyngeal) space through contiguous spread or regional lymphatics.
• This invasion triggers severe localized inflammation and septic thrombophlebitis within the adjacent internal jugular vein.
• Patients present with unilateral neck swelling, tenderness along the sternocleidomastoid muscle, spiking fevers with rigors, and signs of systemic sepsis.
• Metastatic septic emboli frequently shower the lungs (causing cavitary nodular infiltrates, empyema, and hemoptysis) and large joints (septic arthritis).
• Contrast-enhanced CT of the neck is the imaging modality of choice, demonstrating intraluminal filling defects in the IJV with surrounding soft tissue inflammation.
Final Answer:
Lemierre's syndrome refers to internal jugular vein septic thrombophlebitis and bacteremia following a primary oropharyngeal infection.
Lemierre's syndrome (post-anginal septicemia) is a severe, potentially fatal complication of acute bacterial pharyngitis/tonsillitis seen predominantly in healthy adolescents and young adults.
It is classically characterized by an antecedent oropharyngeal infection leading to secondary septic thrombophlebitis of the internal jugular vein (IJV) and disseminated septic embolization.
Explanation:
• The primary causative organism in the vast majority of cases is Fusobacterium necrophorum, an obligate anaerobic, gram-negative bacillus that is part of the normal oral flora.
• The disease begins as a primary oropharyngeal infection (pharyngitis, peritonsillar abscess, or tonsillitis) that invades the lateral pharyngeal (parapharyngeal) space through contiguous spread or regional lymphatics.
• This invasion triggers severe localized inflammation and septic thrombophlebitis within the adjacent internal jugular vein.
• Patients present with unilateral neck swelling, tenderness along the sternocleidomastoid muscle, spiking fevers with rigors, and signs of systemic sepsis.
• Metastatic septic emboli frequently shower the lungs (causing cavitary nodular infiltrates, empyema, and hemoptysis) and large joints (septic arthritis).
• Contrast-enhanced CT of the neck is the imaging modality of choice, demonstrating intraluminal filling defects in the IJV with surrounding soft tissue inflammation.
Final Answer:
Lemierre's syndrome refers to internal jugular vein septic thrombophlebitis and bacteremia following a primary oropharyngeal infection.
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