A case report of an atypical presentation of Lemierre syndrome with extensive central nervous system complications

Lemierre syndrome (LS) is a rare but serious bacterial infection that originates in the oropharynx and is characterized by septic thrombophlebitis of the internal jugular veins. Septic emboli commonly affect other organs, such as the lungs, kidneys, and liver, with central nervous system (CNS) involvement being a rare occurrence. It predominantly affects young adults following an oropharyngeal infection with Fusobacterium species. We present an atypical presentation of LS in a 75-year-old male caused by Streptococcus intermedius, demonstrating extremely rare CNS involvement. Findings included extensive venous thrombophlebitis, bilateral cavernous sinus thrombosis, venous infarction, and subarachnoid hemorrhage. Radiographic imaging, particularly contrast-enhanced computed tomography (CT) scans, played a critical role in diagnosis and management. This case underscores the importance of maintaining a high index of suspicion for LS, especially in atypical presentations, and utilizing imaging for early diagnosis and intervention to improve patient prognosis.