A variation of Lemierre’s syndrome ?

We discussed a 26 yo M with active IVDU who was admitted for left axillary abscess with surrounding acute deep vein thrombosis/thrombophlebitis alongwith multiple septic emboli (some with cavities) in his lungs. Discussion was focused on differential diagnosis for such a presentation and then management.

Lemierre’s syndrome was originally described as oropharyngeal infection (mostly with Fusobacterium necrophorum ) leading to infectious throbophlebitis in internal jugular vein progressing to septic emboli in the lungs. The case above was different in presentation but there is similarity in pathophysiology and can be argued to be a variation of this.

We also discussed the management of acute DVT with suppurative thrombophlebitis and the role of anti-coagulation added to systemic antibiotics. There is controversial but a paper on a review of such cases looked at this. Although the paper has its limitations, it just points out that this can be considered as a management option with possibly favorable outcomes.