Lemierre's syndrome (LS), described in detail in 1936, used to be a life-threatening entity until the advent of
antibiotics.
Tonsillitis or
pharyngitis are the main primary
infections and oropharyngeal anaerobic flora is the predominant etiology. However, other primary site
infections, as well as other microbiological agents have been reported since the first description. Inflammatory symptoms in the neck and marked findings on physical examination predominate the majority of cases. Nonetheless, the authors report the case of a 54-year-old man with a history of
dysphagia followed by
cough, purulent expectoration, and
fever. The bad condition of his dentition was noteworthy. During the diagnostic work-up, an ulcerated lesion in the uvula and a middle lobe
pneumonia were disclosed. Streptococcus viridans was isolated from blood culture. On the fifth day of hospitalization, the patient died after a copious episode of
hemoptysis. The autopsy findings depicted an
abscess within a
squamous cell carcinoma of the uvula,
pharyngitis with carotid sheath spreading accompanied by pylephlebitis and
thrombosis of the internal jugular vein up to the innominate vein, surrounded by an
abscess in the mediastinum. Alveolar
hemorrhage and
pneumonia were also present. We conclude that the ulcerated
carcinoma of the uvula housed an
abscess, facilitated by the poor
oral hygiene, which triggered LS and the descending
mediastinitis. Pulmonary involvement was due to the septic
embolism from the internal jugular vein. We would like to highlight the uvula
abscess as the primary site of
infection in this case of LS with S. viridans as the causative agent.