Objective:

NA

Background:

Lemierre syndrome is an uncommon, potentially life-threatening condition characterized by internal jugular vein (IJV) thrombophlebitis following an oropharyngeal infection.  Fusobacterium necrophorum is the typical causative organism, and infections caused by other species are referred to as “Lemierre-like” syndromes. Cervical epidural abscess is a very rare complication that requires early recognition and prompt treatment to prevent neurological consequences.  

Design/Methods:

NA

Results:

A 54-year-old immunocompetent male presented with headaches, painful left-sided neck swelling, and left upper extremity weakness for three weeks. Prior to presentation, he was treated with corticosteroids for a presumed viral infection, which likely contributed to the rapid progression of his symptoms. Physical exam revealed an erythematous fluctuant swelling extending from the left side of his neck to his chest accompanied by decreased strength and diminished reflexes in his left upper extremity. MRI revealed IJV thrombosis and a cervical epidural abscess extending from C2 to C6. There was also abnormal signal intensity and enhancement involving the roots and trunks of the left brachial plexus with inflammatory changes consistent with plexitis. Blood and abscess cultures grew MSSA. The patient was managed conservatively with prolonged intravenous antibiotics, leading to gradual improvement in neurological deficits. Surgical decompression was deferred due to the non-compressive nature of the abscess.  

Conclusions:

This case highlights several important learning points for clinicians. Lemierre syndrome and its variants can present with unusual complications such as epidural abscesses that can have devastating neurological consequences.  When a patient presents with signs of a systemic infection and new focal neurological deficits, it is important to keep spinal cord or peripheral nerve involvement in mind. While surgical intervention is often considered in spinal epidural abscess to relieve compression, conservative treatment may be sufficient in select patients when imaging supports an inflammatory rather than compressive etiology.