Lemierre’s syndrome presenting with arterial and Central nervous system involvement

TL;DR

A 17-year-old male developed a rare form of Lemierre’s syndrome with severe brain and artery complications, highlighting the need for early recognition of such complications.

Contribution

This case presents a rare arterial and central nervous system complication of Lemierre’s syndrome, expanding its known clinical manifestations.

Findings

The patient exhibited acute neurological decline with brain infarctions, meningitis, and abscesses.

Imaging revealed internal carotid artery narrowing, venous sinus thrombosis, and intracerebral abscesses.

No primary cause for vasculitis was identified, suggesting Lemierre’s syndrome as the underlying pathology.

Abstract

A 17-year-old male presented with acute onset right-sided facial swelling, trismus, pharyngitis, and sepsis. An initial CT abdomen and pelvis revealed multifocal bilateral nodular cavitary lung lesions. CT soft tissue neck with contrast demonstrated a parapharyngeal abscess and thrombophlebitis of the right internal jugular vein. The patient was subsequently diagnosed with Lemierre’s syndrome. On the following day, the patient’s neurological status markedly declined. Brain MRI/MRA/MRV showed right internal carotid artery narrowing, multiple areas of acute and subacute infarctions secondary to vasculitis, meningitis, venous sinus thrombosis, and intracerebral abscesses. Workup for primary causes of intracranial vasculitis was negative. Although commonly presented as venous disease, this case highlights a rare presentation of Lemierre’s syndrome with arterial involvement and significant intracranial complications. Clinicians should consider vasculitis and central nervous system involvement as potential complications of Lemierre’s syndrome rather than searching for separate aetiologies.

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