# Lemierre's Syndrome Caused by Klebsiella pneumoniae: Case Report and Review of the Literature

## TL;DR

This paper reports a rare case of Lemierre's syndrome caused by Klebsiella pneumoniae in a diabetic patient and reviews similar cases to highlight key risk factors and treatment strategies.

## Contribution

The paper documents the second case of Klebsiella pneumoniae–associated Lemierre's syndrome in Nicaragua and emphasizes early diagnosis and treatment in diabetic patients.

## Key findings

- Diabetes mellitus is the predominant risk factor for K. pneumoniae–associated Lemierre's syndrome.
- Odontogenic or oropharyngeal disease is the most common infection source.
- Septic pulmonary emboli are a hallmark manifestation of the condition.

## Abstract

Klebsiella pneumoniae
is an uncommon but increasingly recognized cause of Lemierre's syndrome, a condition classically associated with
Fusobacterium necrophorum. This report describes a 32‐year‐old woman with poorly controlled type 2 diabetes mellitus who presented with a progressive odontogenic infection complicated by internal jugular vein thrombosis and cavitary septic pulmonary emboli. Imaging demonstrated a deep neck abscess with adjacent thrombophlebitis, and cultures from surgical drainage yielded
K. pneumoniae
with a wild‐type susceptibility profile. The patient required invasive mechanical ventilation, broad‐spectrum antibiotics, surgical source control, and therapeutic anticoagulation, resulting in complete clinical recovery. A review of published cases from 1996 to 2025 was performed, highlighting diabetes as the predominant risk factor, odontogenic or oropharyngeal disease as the most common source, and septic pulmonary emboli as a hallmark manifestation. This case represents the second documented instance of
K. pneumoniae
–associated Lemierre's syndrome in Nicaragua and reinforces the need for early imaging, prompt surgical management, and targeted antimicrobial therapy in diabetic patients presenting with deep neck infections.

Klebsiella pneumoniae
represents an emerging atypical etiology of Lemierre's syndrome, particularly among patients with diabetes mellitus. This case highlights the critical role of early diagnostic imaging, prompt surgical source control, and pathogen‐directed antimicrobial therapy in severe odontogenic infections complicated by jugular vein thrombosis and septic pulmonary emboli.

Axial contrast‐enhanced chest CT demonstrating multiple peripheral cavitary nodules and consolidations, predominantly in the right lower lobe, consistent with septic pulmonary emboli (arrows).