Presentations of septic jugular thrombophlebitis

Septic jugular thrombophlebitis (Lemierre syndrome) develops due to haematogenous spread of anaerobic bacteria (classically Fusobacterium necrophorum) from oropharyngeal infection, although the infection is typically polymicrobial. Staphylococcus aureus (including methicillin-resistant S. aureus [MRSA]) can also cause septic jugular thrombophlebitis. It usually presents with or following oropharyngeal infection in the preceding weeks. Local signs include trismus, neck tenderness and neck pain. Dyspnoea, pleurisy or haemoptysis secondary to septic pulmonary emboli, including lung abscess, frequently occur. More distal manifestations of septic emboli may also be present. Have a high index of suspicion for septic jugular thrombophlebitis in patients who present with neck pain or pulmonary manifestations following recent pharyngitis (sore throat).

Seek expert advice for nonantibiotic management of septic jugular thrombophlebitis. In addition to antibiotic therapy, surgical drainage and debridement of abscesses is often needed – early surgical consultation is recommended. The role of anticoagulation is controversial; a multidisciplinary approach should be taken to determine the risks and benefits of anticoagulation for the patient, involving clinicians with relevant expertiseAdedeji, 2021Campo, 2019Foo, 2021Johannesen, 2016Valerio, 2021. If echocardiography confirms endocarditis, see Approach to managing infective endocarditis and seek expert advice for treatment choice.