Lemierre’s Syndrome

Lemierre’s (pronounced “la-MEERs”) syndrome is a potentially fatal complication that can develop from an infection in your upper respiratory tract — usually your throat. It can cause painful inflammation and infected blood clots (septic thrombophlebitis) in your jugular vein. These blood clots can spread to your:

• Bones
• Brain
• Liver
• Lungs
• Meninges

Lemierre’s syndrome is rare. There are fewer than 4 cases per 1 million people per year in the U.S. Most cases affect adolescents and young adults. But the number of cases has increased over the last several years. This may be because the medicines that usually treat Lemierre’s syndrome no longer kill the infection (antibiotic resistance).

The name comes from the French physician André Lemierre. He reported cases of the condition in the 1930s. Healthcare providers sometimes call it Lemierre disease.

Symptoms of Lemierre’s syndrome

The first symptom is usually a sore throat. But other Lemierre’s syndrome symptoms include:

• Cough that produces blood or bloody mucus
• Fatigue
• Fever
• Headache
• Light sensitivity
• Muscle stiffness or soreness
• Nausea and vomiting
• Swollen lymph nodes in your neck
• Tonsil infection
• Trouble breathing or swallowing

Lemierre’s syndrome causes

The bacterium Fusobacterium necrophorum (F. necrophorum) causes over 8 out of 10 cases of Lemierre’s syndrome. People naturally carry F. necrophorum in their bodies. It appears in the:

• Throat
• Gastrointestinal tract (mouth, esophagus, stomach, and small and large intestines)
• Male and female reproductive (genitourinary) systems

Other bacteria that may cause Lemierre’s syndrome include:

• Fusobacterium nucleatum (nucleatum)
• Klebsiella pneumoniae (pneumoniae)
• Porphyromonas asaccharolytica (asaccharolytica)
• Staphylococcus species
• Streptococcus species

Risk factors

You’re at a greater risk of getting Lemierre’s syndrome if you’re an adolescent or young adult. Experts aren’t sure why.

Certain bacterial and viral infections may increase your chances of an F. necrophorum infection. These include:

• Cytomegalovirus
• Epstein-Barr virus
• Mononucleosis
• Mycoplasma pneumonia

These infections can damage the mucus membranes in your body. This may allow F. necrophorum to grow and spread more easily.

Is it contagious?

No, Lemierre’s syndrome isn’t contagious. But the bacteria and viruses that cause it can spread from person to person.

Complications

Lemierre’s syndrome complications may include:

• An infected blood clot in your jugular vein can spread to other parts of your body and cause a blockage in other blood vessels (septic emboli)
• Fluid buildup around your lungs (pleural effusion)
• Joint pain, stiffness and inflammation (arthritis)
• Pockets of pus in your lungs (lung abscess)
• Pneumonia
• Pus in the hollow area between your lungs and underneath your chest wall (empyema)

Lemierre’s syndrome can also cause your immune system to overreact to an infection (sepsis). Sepsis is a life-threatening medical emergency.

How doctors diagnose Lemierre’s syndrome

Lemierre’s syndrome can be challenging to diagnose. That’s because it’s rare and shares many symptoms with other common infections. If your symptoms last for a long time or get worse, healthcare providers may first recommend blood tests that check for inflammation in your body. These include:

• C-reactive protein (CRP) test
• Erythrocyte sedimentation rate test

They may also perform a bacteria culture with some of your blood sample.

If blood tests indicate you may have an infection, providers may recommend imaging tests of your neck and throat. They can help identify blood clots in your jugular vein and other signs of infection or complications. These imaging tests may include:

• CT scan
• Ultrasound
• X-rays

How do you treat it?

The first-line treatment for Lemierre’s syndrome is antibiotics like:

• Amoxicillin/clavulanic acid (Augmentin®)
• Clindamycin (Cleocin®)
• Imipenem (Primaxin®)
• Metronidazole (Flagyl®)

In severe cases, you may need surgery to:

• Drain an abscess in your brain, head, lungs or neck
• Drain fluid from around your lungs
• Remove a blood clot from your jugular vein (thrombectomy)
• Remove your tonsils (tonsillectomy)
• Tie off your jugular vein (ligation) to stop blood from entering it

Recovery time

It depends on how severe your case is. It also depends on how you respond to treatment. Most people start to feel better a few days after starting antibiotics. But it may take three to six weeks to make a full recovery.

When should I see my healthcare provider?

Call a healthcare provider if you have a sore throat and other signs of a respiratory infection that don’t go away within a week or get worse. Go to the nearest emergency room immediately if you’re vomiting blood or having trouble breathing or swallowing.

You may want to ask a healthcare provider the following questions:

• What tests will help diagnose Lemierre’s syndrome?
• If I don’t have Lemierre’s syndrome, what other condition might I have?
• Has the infection spread to other areas of my body?
• What treatment do you recommend?
• Do you think I’ll need surgery?
• Do you think I’ll develop any complications?

What can I expect if I have Lemierre’s syndrome?

With a quick diagnosis and treatment, most people survive Lemierre’s syndrome and are less likely to develop complications. Without treatment, complications can be severe and even fatal. Healthcare providers will give you a better idea of what to expect.

Can it be prevented?

You can help reduce your risk of getting infections that could lead to Lemierre’s syndrome by:

• Avoiding others if they’re sick
• Avoiding sharing food and utensils with others, especially if they’re sick
• Regularly brushing and flossing your teeth, rinsing with antibacterial mouthwash and scheduling regular check-ups with a dentist (oral hygiene)

Is Lemierre’s syndrome an STD?

No, healthcare providers don’t consider Lemierre’s syndrome a sexually transmitted infection (STI). But the P. asaccharolytica is a rare cause of Lemierre’s syndrome. P. asaccharolytica doesn’t usually exist in your mouth or throat. It’s more common in your genitals and gastrointestinal (GI) tract. Healthcare providers believe the bacterium may spread from the genitals to the mouth after oral sex. Providers don’t consider Lemierre’s syndrome an STI because oral sex isn’t the main way that the infections that cause Lemierre’s syndrome spread.

Can it come back?

It’s possible to get Lemierre’s syndrome twice. But it’s very rare.