Lemierre syndrome: Presentation of three cases

A high degree of clinical suspicion is needed if symptoms from oropharyngeal infection or from any of the mentioned sources are accompanied or followed by a presentation suggestive of IJV thrombophlebitis, sepsis, or septic emboli. More specifically, in older children and young adults who, after a throat infection, develop persistent fever, swelling, or pain of the lateral neck, especially if pulmonary signs and symptoms are present, serious conjecture should be used. Persistent fever may be the only physical evidence, particularly during the earlier phases of the disease. As previously mentioned, oropharyngeal examination findings may not be diagnostic, and the syndrome is frequently unsuspected until microbiology results are available. Early recognition of the syndrome is crucial to allow the initiation of immediate appropriate therapy because microbiologie confirmation may take several days. In a review of 14 pediatric cases, there was a significant delay in making the diagnosis, with a mean of 5 days from the time of admission and a range of 2 to 23 days. Furthermore, several other reports indicate a diagnosis being made only after the blood cultures came back positive for F. necrophorum. Hence, we stress the importance of taking early blood cultures and carrying out a careful examination of the neck in suspicious patients presenting with a severe oropharyngitis. Blood cultures should be obtained, even in the absence of neck findings. Furthermore, contrast-enhanced CT should be performed as early as possible because physical examination of the neck and ultrasonography may be negative for thrombosis of the IJV in some cases.