Lemierre’s Syndrome with Neck Phlegmon Following Otitis Media in A Patient with ‎Rheumatic Heart Disease Disease: A Case Report from Ethiopia

  • Authors

    • Habib Abdela Seid Department of Internal Medicine, College of Medicine and Health Sciences, ‎ Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
    • Samrawit Andarge kassa Department of Surgery, College of Medicine and Health Sciences, ‎Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
    • Eyob Ayenew Engidaw Department of Surgery, College of Medicine and Health Sciences, ‎Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia https://orcid.org/0009-0001-4819-6597
    • Dessie Enyew Ayenew Department of Emergency and Critical Care Medicine, College of Medicine and ‎Health Sciences, Comprehensive Specialized Hospital, University of Gondar, ‎Gondar, Ethiopia
    • Mebratu Amsalu Manamino Department of Radiology, College of Medicine and Health Sciences, ‎Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
    • Asteway Gashaw Teshome Department of Pathology, College of Medicine and Health Sciences, ‎Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
    https://doi.org/10.14419/bfd6vp70

    Received date: September 3, 2025

    Accepted date: October 24, 2025

    Published date: November 4, 2025

  • Lemierre’s Syndrome; Internal Jugular Vein Thrombosis; Otitis Media; Rheumatic Heart ‎Disease; Case Report

  • Abstract

    Introduction: Lemierre’s syndrome is a rare septic thrombophlebitis of the internal ‎jugular vein, classically following oropharyngeal infection. Once common in the pre-‎antibiotic era, it is now termed the “forgotten disease.” Otitis media as a preceding ‎infection is exceptional.‎

    Case Presentation: A 33-year-old Ethiopian woman with rheumatic heart disease ‎presented with fever, sore throat, dysphagia, and right-sided neck swelling after ‎untreated otitis media. Ultrasound confirmed a right neck abscess with internal jugular ‎vein thrombosis. She was treated with intravenous ceftriaxone and metronidazole, ‎underwent surgical drainage, and was anticoagulated. She improved after two weeks of ‎hospital stay and was discharged on oral antibiotics and warfarin.‎

    Discussion: Lemierre’s syndrome typically follows pharyngeal infections. Diagnosis ‎requires imaging, with CT being the gold standard, but ultrasound remains essential ‎where resources are limited. Prolonged antibiotics are the mainstay, and the role of ‎anticoagulation is debated.‎

    Conclusion: This case highlights the importance of maintaining suspicion for ‎Lemierre’s syndrome in patients with head and neck infections, even when the source is ‎otitis media, particularly in resource-limited regions. It sends a message to policy ‎makers. They need to improve diagnostic imaging, like CT scans, in resource-limited ‎settings. It also underscores the need to have guidelines or protocols for Lemierre’s ‎syndrome diagnosis and management, especially on the use of anticoagulants‎.

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  • How to Cite

    Abdela Seid, H., Andarge kassa, S. ., Ayenew Engidaw, E. . ., Enyew Ayenew , D. ., Amsalu Manamino , M. ., & Gashaw Teshome, A. . (2025). Lemierre’s Syndrome with Neck Phlegmon Following Otitis Media in A Patient with ‎Rheumatic Heart Disease Disease: A Case Report from Ethiopia. International Journal of Medicine, 13(2), 1-5. https://doi.org/10.14419/bfd6vp70