Authors: Matteo Doneddu , Francesco Marongiu

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Article Info

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Abstract

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Introduction: We describe here a case of a woman admitted to our Internal Medicine Unit for multifocal pneumonia. During the stay, she presented a few neurological symptoms: headache, nausea, emesis, photophobia, and gait disturbance. Methodology: Chest computed tomography (CT) detected multiple areas interpreted as septic emboli. Moreover, a left internal jugular thrombosis (LIJT) was incidentally reported. A CT-angiography showed the LIJT extension to cerebral sinuses. Ear, nose, and throat consultation revealed a left medium otitis. Anticoagulation with Fondaparinux was associated to antibiotic therapy with improvement in neurological symptoms that totally remitted over the next 2 weeks. Results: These findings confirmed the diagnosis of a Lemierre's Syndrome with thrombosis extension to cerebral sinuses. The genetic thrombophilic panel showed a heterozygosis for prothrombin gene G20210A mutation and the patient was discharged with Rivaroxaban for home continuation of anticoagulant therapy for at least 6 months. Conclusion: The prevalence of inherited thrombophilias in Lemierre's Syndrome is unknown and to our knowledge, this article is the first to identify a prothrombin gene G20210A mutation in a patient with Lemierre's Syndrome with thrombosis extension into the cerebral venous system. Exploring patients with Lemierre's Syndrome for underlying thrombophilia could clarify whether this promotes retrograde jugular vein thrombosis extension.

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Keywords: Case report, Lemierre's Syndrome, thrombophilia, cerebral vein thrombosis, DOACs, green

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