# Association of Pulmonary Septic Embolism and Pulmonary Arterial Thromboembolism in Lemierre Syndrome: A Case Report and Literature Review

## TL;DR

This case report describes a rare instance of Lemierre syndrome in a 65-year-old woman with both septic pulmonary emboli and pulmonary arterial thromboembolism.

## Contribution

The paper highlights a rare association of pulmonary arterial thromboembolism and septic emboli in Lemierre syndrome.

## Key findings

- The patient showed bilateral internal jugular vein thrombophlebitis and multiple septic emboli in the lungs.
- Pulmonary arterial thromboembolism was confirmed alongside septic emboli via CT pulmonary angiography.
- Complete resolution of symptoms and imaging findings was observed after antibiotic and anticoagulant treatment.

## Abstract

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.

We report a rare presentation of Lemierre's syndrome in a 65‐year‐old woman, characterised by the coexistence of septic pulmonary emboli and pulmonary arterial thromboembolism, both documented on CT pulmonary angiography.