Thrombophlebitis of the internal jugular vein is becoming less rare in the 21st century

Published in the International Journal of Emergency Medicine; the following abstract which points out the condition is characterized by thrombophlebitis. My daughter Bri still follows a regimen of anticoagulation with warfarin (blood thinner).

"Lemierre’s syndrome is a condition characterized by thrombophlebitis of the internal jugular vein and bacteremia caused by primarily anaerobic organisms, following a recent oropharyngeal infection. This has been an uncommon illness in the era of antibiotic therapy, though it has been reported with increasing frequency in the past 15 years. Lemierre’s syndrome should be suspected in young healthy patients with prolonged symptoms of pharyngitis followed by symptoms of septicemia or pneumonia, or an atypical lateral neck pain. Diagnosis is often confirmed by identification of thrombophlebitis of the internal jugular vein and growth of anaerobic bacteria on blood culture. Treatment involves prolonged antibiotic therapy occasionally combined with anticoagulation."

Common findings in this particular report:

1. Fever is the most common physical finding, present in 92% of 100% of cases.

2. Followed by Pharyngitis or peritonsillar abscess and neck mass. A mass in the neck may be palpable at the angle of the jaw.

3. Frequently, a mass in this location is mistaken for enlarged lymph nodes. 

My daughter had excruciating neck pain, but we and her doctors in the ER mistook it for throat pain.

Lemierre's Syndrome: What is it?

I have learned a few things over the years about Lemierre's Syndrome: 

1. The medical term is REALLY hard to remember! ie., also known as postanginal sepsis and human necrobacillosis.

2. Lemierre's is called a syndrome or/and a disease. It is the  the occurrence of thrombophlebitis of the internal jugular vein (IJV) in the presence of an oropharyngeal infection.

3. It's commonly found in the mouth.

4. What are symptoms? Starts with sore throat, fever, weakness, neck swelling and progresses to shortness of breath, chest pain and possibly respiratory failure.

5. What are the characteristics? Septic blood clot formation in a jugular neck vein with emboli frequently traveling into the lungs and possibly joints and brain. 

6. What is treatment? Treatment includes antibiotics along with other measures such as ventilation, blood thinners, surgery and chest tubes. 

In Bri's case, she underwent two surgeries and then later when they found blood clots in her lungs and arms (yes, arms!) she began blood thinner therapy.

This disease was SO tough to diagnose because it appeared she had strept throat or something similar. Before she was diagnosed, I kept thinking, well, maybe she has one of those rare flus that strike people and there is no cure. In her case, the blood test was the first responder of saving her life! Because it found out she had sepsis (bacteria) in her blood. 

I hope these simple bullet points help someone searching for an answer to an unknown and undiagnosed case of Lemierre's Syndrome.