Lemierre's Syndrome: Atypical Presentation of the Internal Carotid Artery and Jugular Vein Fistula—CaseReport and Review

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Abstract Background: Lemierre's syndrome (LS) is a rare yet potentially life-threatening complication of oropharyngeal infections that is typically characterized by septic thrombophlebitis of the internal jugular vein and is commonly associated with Fusobacterium necrophorum. Despite its recognition since 1936, LS can present atypically, as seen in our case where a patient exhibited a rare complication of an internal carotid artery and jugular vein fistula. This case highlights the diagnostic and therapeutic challenges that can arise and underscores the importance of both a broader awareness of LS and the necessity for a multidisciplinary approach. Case Presentation: A 42-year-old male who was initially diagnosed with a periodontal abscess and tonsillitis later developed internal jugular vein thrombophlebitis. This progressed to an internal carotid to internal jugular vein fistula, leading to septic thrombosis of the left internal carotid and jugular vein and eventually culminating in a carotid bulb aneurysm and subsequent cerebral infarct. The patient also experienced septic emboli, resulting in lung and mediastinal abscesses. Treatment involved intravenous antibiotics, anticoagulant therapy, and vascular repair, yielding a favorable outcome. Conclusions: This case underscores the intricate nature of LS, showing its potential to progress to severe septic complications, including rare vascular issues and cerebral infarction. The diagnostic complexities and therapeutic interventions emphasize the critical importance of early identification, prompt diagnosis, and multidisciplinary management of LS to prevent life-threatening outcomes.

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