Incomplete Lemierre’s syndrome: a case report

Incomplete Lemierre’s syndrome is a bacterial oropharyngeal infection, complicated by septic emboli to end organs, but without thrombophlebitis of the internal jugular vein. We want to strengthen and raise awareness of the new concept of an incomplete Lemierre’s syndrome and demonstrate that anticoagulation therapy should not be started systematically in the incomplete form.

We discuss the cases of one 23-year-old Belgian man and a 20-year-old Belgian Turkish man who presented to the emergency room with oropharyngeal infection and pulmonary septic emboli, without thrombophlebitis of the internal jugular vein. In both cases, Fusobacterium necrophorum was isolated and appropriate antibiotic therapy was started.

As these patients met all the criteria for Lemierre’s syndrome except for internal jugular vein thrombophlebitis, they illustrate the relevance of the concept of incomplete Lemierre’s syndrome. Both cases underline the importance to include this condition in the differential diagnosis and contribute to the discussion of whether anticoagulation should be started in patients with incomplete Lemierre’s syndrome.