SHM Converge Scientific Abstract ePoster Gallery-Neck Pain: A Clot to Talk About

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This case report describes a 15-year-old previously healthy male who presented with fever, fatigue, headache, neck stiffness, throat pain, and cognitive slowing. Because his symptoms initially raised concern for meningitis, he was started on vancomycin and ceftriaxone and admitted. However, examination revealed significant left tonsillar enlargement, cervical lymphadenopathy, and a “hot potato” voice, shifting concern toward a deep neck space infection rather than meningitis.<br /><br />Further workup, including negative viral, strep, mono, and CSF studies, supported this revised differential. CT imaging showed a left para-pharyngeal abscess extending to the jugular foramen, complete occlusion of the left internal jugular vein, and later CTA confirmed Lemierre’s syndrome with thrombosis extending into the sigmoid and transverse venous sinuses, plus an epidural abscess and phlegmon causing severe internal carotid artery narrowing. ENT performed incision and drainage of the abscess. Because of the extensive clot burden, anticoagulation with enoxaparin was started after consultation with neurology and hematology. Cultures ultimately grew Streptococcus viridans. The patient was discharged on enoxaparin and a 6-week course of oral linezolid and metronidazole.<br /><br />The report emphasizes that Lemierre’s syndrome is a rare but potentially life-threatening complication of pharyngitis or tonsillitis, most commonly caused by Fusobacterium necrophorum but also other bacteria including Streptococcus species. It can progress to septic thrombophlebitis, bacteremia, and septic emboli. The authors highlight the importance of careful physical examination and avoiding anchoring bias, since deep neck infections can mimic meningitis. Early recognition, imaging, prolonged antibiotics, and sometimes surgery or anticoagulation are key to preventing serious complications.

Asset Subtitle

Anna Q. Allen

Meta Tag

Author List Anna Q. Allen, Sherin John, Wilfred Njmenza

Category Clinical Vignettes

Concept Lemierre Syndrome

Concept Internal Jugular Vein Thrombosis

Concept Retropharyngitis

Concept Antibiotic Therapy

Concept Bacterial Tonsillitis

Distinguished Non-Finalist

Presenter Organization University of Tennessee Heath Science Center

Presenting Author Anna Q. Allen

Track Pediatric

Keywords

Lemierre syndrome

para-pharyngeal abscess

internal jugular vein thrombosis

deep neck infection

tonsillitis

cervical lymphadenopathy

septic thrombophlebitis

Streptococcus viridans

anticoagulation

linezolid

Lemierre Syndrome

Internal Jugular Vein Thrombosis

Retropharyngitis

Antibiotic Therapy

Bacterial Tonsillitis