Authors: Hasan Sultanoğlu , Emre Erdem

Abstract

Background: Lemierre syndrome is a rare but potentially life-threatening condition classically characterized by recent oropharyngeal infection, septic thrombophlebitis of the internal jugular vein, and septic embolization. However, severe deep neck infections may occasionally present with clinical features that mimic Lemierre syndrome, even when internal jugular vein thrombosis, septic embolization, and positive cultures are absent.
Case Presentation: A 21-year-old previously healthy man presented to the emergency department with altered mental status following a two-week history of sore throat. Fever, chills, dyspnea, and confusion had developed within the previous 24 hours. On admission, he was febrile, tachypneic, confused, and poorly cooperative. Laboratory investigations revealed neutrophilic leukocytosis and elevated inflammatory markers. Contrast-enhanced neck computed tomography demonstrated a right-sided peritonsillar/parapharyngeal abscess measuring 18 × 28 × 54 mm with obliteration of the parapharyngeal fat planes. However, no evidence of internal jugular vein thrombosis or septic pulmonary embolism was identified. The patient was admitted to the intensive care unit and treated with intravenous piperacillin–tazobactam therapy. Surgical drainage and tonsillectomy were subsequently performed. Blood and abscess cultures remained negative. The patient showed progressive clinical improvement and was discharged on the 21st hospital day without neurological sequelae or other complications.
Conclusion: This case highlights a severe deep neck infection with Lemierre-like clinical features but without radiologically detectable internal jugular vein thrombosis, septic embolization, or positive cultures. Therefore, the case should not be interpreted as classical Lemierre syndrome, but rather as a Lemierre-mimicking presentation requiring early imaging and prompt treatment. Emergency physicians should maintain clinical suspicion for Lemierre syndrome in young patients presenting with
prolonged sore throat, deep neck infection, and systemic toxicity even in the absence of classical radiological findings. Early
imaging and prompt antimicrobial treatment remain essential for reducing morbidity and potentially fatal complications.

Keywords: Lemierre syndrome, deep neck infection, emergency department, internal jugular vein thrombosis, peritonsillar abscess.