Early recognition and management of Lemierre’s syndrome with extensive central venous thrombosis: a case from the emergency department

Lemierre’s syndrome is a rare but potentially life-threatening condition. It typically develops as a complication of oropharyngeal infections, leading to bacteremia, septic thrombophlebitis of the internal jugular vein (IJV), and metastatic septic emboli. According to the literature, Lemierre’s syndrome predominantly affects previously healthy young adults, with a mean age at presentation of around 20 years, although it has also been reported in school-aged children. Diagnosis is frequently delayed or missed, as the initial manifestations—such as sore throat or neck pain—closely resemble benign viral infections. Emergency physicians therefore play a critical role in recognizing early warning signs and initiating prompt, lifesaving management. This report describes an atypical presentation of Lemierre’s syndrome in a middle-aged (43-year-old) woman who exhibited minimal systemic toxicity despite extensive central venous involvement.