Atypical Lemierre's Syndrome Presenting With Extensive Neurovascular Complications and Multifocal Ischemic Stroke

Lemierre's syndrome is a rare condition classically characterized by septic thrombophlebitis of the internal jugular vein following an oropharyngeal infection.We report a case of a previously healthy 19-year-old man who initially presented with gastrointestinal and constitutional symptoms (nausea, vomiting, diarrhea, fever, and malaise) and thrombocytopenia and was treated with corticosteroids for presumed immune thrombocytopenia, with subsequent neurological deterioration associated with carotid artery occlusion, venous sinus thrombosis, and multifocal cerebral infarctions.Further evaluation revealed skull base osteomyelitis, meningitis, and septic pulmonary emboli.Microbial cell-free DNA (mcfDNA) testing identified Fusobacterium necrophorum, leading to a diagnosis of Lemierre's syndrome.The patient underwent surgical debridement and received prolonged intravenous antibiotics and anticoagulation, with gradual clinical improvement.This case highlights an atypical presentation of Lemierre's syndrome lacking the classic pharyngeal symptoms and emphasizes the importance of early recognition in patients with unexplained thrombosis and neurological complications.