Association of pulmonary septic embolism and pulmonary arterial thromboembolism in Lemierre syndrome. A case report and literature review

Lemierre syndrome (LS) is a rapidly progressing disease characterised by a recent oropharyngeal infection, complicated by septic emboli and thrombophlebitis of the internal jugular vein (IJV). We describe a case of a 65-year-old woman who presented to the emergency room with a 14-day history of progressive occipital headache, fever and odynophagia. Radiological investigations showed bilateral IJV thrombophlebitis, multiple cavitated pulmonary nodules suggestive of septic emboli and a subsegmental pulmonary arterial thromboembolism. A diagnosis of LS was made. The patient received antibiotic treatment with intravenous ceftriaxone and clindamycin for 2 weeks, followed by 4 weeks of oral clindamycin at home and anticoagulation with enoxaparin followed by warfarin. One-month follow-up imaging revealed complete resolution of IJV thrombosis and pulmonary findings. This case displayed the rarely reported association of pulmonary arterial thromboembolism and pulmonary septic emboli.