Severe peritonsillar/parapharyngeal abscess mimicking Lemierre syndrome without ınternal jugular vein thrombosis: An emergency department case report

Background

Lemierre syndrome is a rare but potentially life-threatening condition classically characterized by recent oropharyngeal infection, septic thrombophlebitis of the internal jugular vein, and septic embolization. However, severe deep neck infections may occasionally present with clinical features that mimic Lemierre syndrome, even when internal jugular vein thrombosis, septic embolization, and positive cultures are absent. Case Presentation: A 21-year-old previously healthy man presented to the emergency department with altered mental status following a two-week history of sore throat. Fever, chills, dyspnea, and confusion had developed within the previous 24 hours. On admission, he was febrile, tachypneic, confused, and poorly cooperative. Laboratory investigations revealed neutrophilic leukocytosis and elevated inflammatory markers. Contrast-enhanced neck computed tomography demonstrated a right-sided peritonsillar/parapharyngeal abscess measuring 18 × 28 × 54 mm with obliteration of the parapharyngeal fat planes. However, no evidence of internal jugular vein thrombosis or septic pulmonary embolism was identified. The patient was admitted to the intensive care unit and treated with intravenous piperacillin–tazobactam therapy. Surgical drainage and tonsillectomy were subsequently performed. Blood and abscess cultures remained negative. The patient showed progressive clinical improvement and was discharged on the 21st hospital day without neurological sequelae or other complications.