Presentation
Recent history of tonsillitis. Now with persistent hypoxemia.
Patient Data
The left palatine tonsil is enlarged and exhibits mild mass effect on the oropharyngeal airway. There is an ill-defined collection within the palatine tonsil.
There is extensive thrombosis within the left retromandibular vein, left internal jugular vein, and left anterior jugular vein. There is segmental distension of the involved veins and the surrounding fat planes are edematous
There are multiple lung nodules (soft tissue window, lung window) within the bilateral upper lobes and a left pleural fluid collection.
Case Discussion
This is a case of Lemierre syndrome.
The patient was originally hypotensive upon presentation and required admission to the intensive care unit for fluid resuscitation and vasopressors. Blood cultures were positive for Fusobacterium necrophorum. He was started on IV antibiotics. A repeat CT of the neck showed further progression of the thrombosis. The patient was started on heparin drip for anticoagulation. The source of the infection was felt to be secondary to tonsillitis. He subsequently had a tonsillectomy and pathology revealed findings compatible with chronic tonsillitis. Following the tonsillectomy, the patient started to improve and anticoagulation was eventually stopped. He was provided with long-term antibiotics.
Co-author:
Morgan Zhao, MD
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