Atypical Lemierre syndrome, thrombophlebitis of the facial vein

A young man complained of fever and left-sided neck pain. Computed tomography (CT) scan of the neck showed a round low-density area with enhancement at the margin. We suspected a deep neck abscess, and the antibiotic treatment was started. After 3 days, CT scan showed that the oval low-density area extended to its junction with the left internal jugular vein. We diagnosed him as having Lemierre syndrome of the facial vein thrombosis. CT scan of the chest showed multiple pulmonary embolisms. The patient started to receive intravenous anticoagulant therapy. The swelling and tenderness of the neck gradually resolved, and the patient improved without complications. Lemierre syndrome is potentially fatal. Prompt diagnosis and appropriate therapy are needed. Radiographic findings are characteristic and facilitate the diagnosis of Lemierre syndrome. A positive scan typically shows a filling deficit representing occlusive thrombus in the internal jugular vein. In this case, it was difficult to diagnose because the patient had thrombus involving only a facial vein. Recently, cases of Lemierre syndrome have increased, so it is necessary to know Lemierre syndrome of the facial vein thrombosis.