Neuro / Head & Neck for Tuesday, April 8th, 2025

Contributed by Seoul National University Children's Hospital
Young-Hoon Choi, and Jung-Eun Cheon.

History

17-year-old girl presenting with fever and left neck pain.

Previously healthy.

Images (Click any image to enlarge)

Question

What is the most likely diagnosis?

Your answer

Please log in to see your results.

Correct answer

Lemierre’s syndrome

Discussion

  • Septic thrombophlebitis of IJV often a/w pulmonary septic emboli
  • Life-threatening complication of bacterial oropharyngeal infection, such as acute pharyngotonsilitis
  • Fusobacterium necrophorum (anaerobic G(-)) is pathognomonic (80%)
  • Clinical presentation
    • Typically develop 4-5 days following an episode of acute pharyngitis
    • Fever, trismus (tightness of the jaw), pain behind the angle of the jaw, neck swelling, chest pain, dyspnea
  • Imaging 
    • Thrombophlebitis of IJV
    • Septic emboli, most commonly in the lung
    • Primary infection (i.e. pharyngitis, tonsilitis)