Patients with Lemierre syndrome have a high risk of new thromboembolic complications, clinical sequelae and death: an analysis of 712 cases

Luca Valerio, Federica Zane, Clara Sacco, Serena Granziera, Tommaso Nicoletti, Mariaconcetta Russo, Gabriele Corsi, Karin Holm, Michel André Hotz, Christian Righini, Petros D. Karkos, Seyed Hamidreza Mahmoudpour, Nils Kucher, Peter Verhamme, Marcello Di Nisio, Robert M. Centor, Stavros V. Konstantinides, Alessandro Pecci, Stefano Barco

Research output: Contribution to journalArticlepeer-review


Background: Lemierre syndrome is characterized by head/neck vein thrombosis and septic embolism usually complicating an acute oropharyngeal bacterial infection in adolescents and young adults. We described the course of Lemierre syndrome in the contemporary era. Methods: In our individual-level analysis of 712 patients (2000–2017), we included cases described as Lemierre syndrome if these criteria were met: (i) primary site of bacterial infection in the head/neck; (ii) objectively confirmed local thrombotic complications or septic embolism. The study outcomes were new or recurrent venous thromboembolism or peripheral septic lesions, major bleeding, all-cause death and clinical sequelae. Results: The median age was 21 (Q1–Q3: 17–33) years, and 295 (41%) were female. At diagnosis, acute thrombosis of head/neck veins was detected in 597 (84%) patients, septic embolism in 582 (82%) and both in 468 (80%). After diagnosis and during in-hospital follow-up, new venous thromboembolism occurred in 34 (5.2%, 95% CI 3.8–7.2%) patients, new peripheral septic lesions became evident in 76 (11.7%; 9.4–14.3%). The rate of either was lower in patients who received anticoagulation (OR: 0.59; 0.36–0.94), higher in those with initial intracranial involvement (OR: 2.35; 1.45–3.80). Major bleeding occurred in 19 patients (2.9%; 1.9–4.5%), and 26 died (4.0%; 2.7–5.8%). Clinical sequelae were reported in 65 (10.4%, 8.2–13.0%) individuals, often consisting of cranial nerve palsy (n = 24) and orthopaedic limitations (n = 19). Conclusions: Patients with Lemierre syndrome were characterized by a substantial risk of new thromboembolic complications and death. This risk was higher in the presence of initial intracranial involvement. One-tenth of survivors suffered major clinical sequelae.

Original languageEnglish
JournalJournal of Internal Medicine
Publication statusAccepted/In press - Jan 1 2020


  • anticoagulation
  • Fusobacterium necrophorum
  • Lemierre syndrome
  • pulmonary embolism
  • septic embolism
  • venous thromboembolism

ASJC Scopus subject areas

  • Internal Medicine


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