# A Rare Case of Lemierre’s Syndrome due to Veillonella Parvula: A Dangerous and Forgotten Complication of a Septic Condition

## TL;DR

A 38-year-old woman developed Lemierre’s syndrome, a rare complication of throat infection, caused by Veillonella Parvula and involving septic thrombophlebitis and lung involvement.

## Contribution

This paper reports a rare clinical case of Lemierre’s syndrome caused by Veillonella Parvula, highlighting its unusual presentation and diagnostic challenges.

## Key findings

- Lemierre’s syndrome was diagnosed in a 38-year-old woman with septic thrombophlebitis of the jugular vein.
- Veillonella Parvula was identified as the causative organism through blood and sputum cultures.
- Imaging and microbiological tests confirmed septic dissemination limited to the neck and lungs.

## Abstract

This clinical case presents an unusual case of Lemierre’s syndrome (LS) in a young woman of 38-year-old. She arrived in the Emergency Department with a high fever and pharyngology resistant to antibiotic therapy with clarithromycin, ceftriaxone, and cortisone for two weeks. At the blood sampling, there is a marked leucocytosis, and the advice of the otolaryngologist is required given the strong pain in the throat. Due to the tonsillar abscess, a neck CT with a contrast medium is necessary for the otolaryngologist’s opinion. The CT shows thrombosis of the jugular vein and left subclavian, with thickening of soft perivascular tissues; these findings suggest Lemierre’s syndrome: a septic thrombophlebitis of the jugular vein that occurs as a complication of a peritonsillar abscess. The diagnostic process is then completed with a chest HR-CT, which reveals lung density and excavation areas suggesting tuberculosis. Blood culture reveals the presence of Veillonella Parvula (an anaerobic gram-negative coccus), sputum culture reveals the presence of some colonies of Enterobacter cloacae complex, real-time PCR examination on sputum reveals the presence of Streptococcus Pneumoniae and the borderline presence of rhinovirus. Microbiologists, after these results and neck and chest CT with a contrast agent, agree with the diagnosis of suspected LS at an early stage: a septic dissemination fortunately limited only to the neck and lungs region.