Deep neck space infection and Lemierre's syndrome caused by Streptococcus anginosus: A case report

Introduction: Deep neck space infections most commonly arise from a septic focus of the mandibular teeth, tonsils, parotid gland, middle ear or sinuses, usually with a rapid onset and frequently with progression to life -threatening complications. Lemierre ?s syndrome is classically de fined by an oropharyngeal infection with internal jugular vein thrombosis followed by metastatic infections in other organs. Case presentation: A 32 -year -old female patient, with no signi ficant past medical history, was diagnosed with a dental abscess on her left inferior 3 rd molar. Six days later, the condition complicated with severe upper respiratory distress, odynophagia and trismus, and extension of the in flammatory signs to the anterior cervical region, involving the upper airway. Computed tomography scan con firmed extension to submandibular, parapharyngeal and retrosternal spaces), which required nasotracheal intubation due to compromised airway. Urgent and subsequent surgical drainages were performed, alongside with concomitant antibiotic therapy. Additionally, left internal jugular vein thrombosis was described - with later extension to the brachiocephalic vein, without other complications, consistent with Lemierre's syndrome, although without full features. Streptococcus anginosus was identi fied in the drained pus specimens. The patient made a satisfactory clinical progress and was discharged after 25 days, still under therapeutic hypocoagulation. Conclusion: As deep neck space infections can be life -threatening, clinicians must be aware and not underestimate their potential severity. Lemierre's syndrome is a complication dif ficult to recognize, which requires additional awareness of the many possible presentations, for appropriate diagnostic studies and therapeutic plan. (c) 2019 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).