An echocardiogram was largely unremarkable. The oropharyngeal biopsies demonstrated, particularly in the vallecula, acute-on-chronic infection but no discrete microbial growth was achieved. The other microbiological samples did not yield any growth on extended culture runs. Subsequent neck ultrasonography confirmed a partially occlusive right internal jugular vein thrombus at the subclavian confluence (Figure 3). A CT neck/thorax confirmed this but did not demonstrate other occult pathology. Anticoagulation therapy with warfarin was subsequently commenced. The patient is now

well and not suffering from any residual disability. Figure 3 >50% occlusive selleck screening library right internal jugular vein thrombus on ultrasonography. Discussion Despite reports of human illnesses caused by what is now known as F. necrophorum appearing within early 20th Tideglusib chemical structure Century literature, the consensus definition of Lemierre’s syndrome remains unclear [5, 77]. The authors undertook a literature review to further clarify these diagnostic criteria. Using the PubMed search engine we utilised the following mesh headings: Lemierre’s (All Text); and Fusobacterium (All Text); and Case (Title/Abstract). The search yielded 96 papers published selleck kinase inhibitor since 1980 from a wide global geographical area inclusive of Asia, South America,

North America and Europe. The authors used only papers which had symptomatic descriptions, bacteriological evidence, radiological evidence and descriptions in English which could possibly demonstrate a definitive diagnosis of Lemierre’s disease. This left 78 identifiable cases in the literature. Analysis of the 78 cases demonstrates that the oropharynx tends to be the primary infective site with 59/78 (77% – see Table 1) of all cases demonstrating symptoms prior to sepsis of an acute oropharyngeal infection. 16/78 (21%) of the remaining cases had primary

infective sites from other anatomical locations. 5/78 (6%) of these cases originated in the ears with symptoms of otitis externa occurring prior to 6-phosphogluconolactonase widespread sepsis. 3/78 (4%) cases originated in the soft tissues in the neck from originally superficial infections of the skin in both the anterior (2/3 cases) and the posterior (1/3 cases) triangles. 3/78 (4%) of cases had syndromic components but no obvious primary infective site. Table 1 Site of primary infection   Oropharynx Cranio-facial Extra cranio-facial Unknown Number of cases reported N = 59 N = 13 N = 3 N = 3   5 Ear 1 Spine   5 Dental 1 Uterus 3 Neck 1 Hand A particularly contentious aspect is whether or not the presence of thrombophlebitis of the internal jugular vein is essential in the diagnosis [77]. In our case, ultrasound and CT confirmed the presence of substantial internal jugular vein (IJV) thrombus. Our literature review demonstrated 54/78 (69% – see Table 2) of reported cases had thrombus in the IJV. In 2/78 (3%) of cases the IJV thrombus propagated cranially resulting in thrombophlebitis of the cranial veins.