Lemierre's syndrome in reverse: A case report

Lemierre's syndrome is unilateral internal jugular vein (IJV) thrombosis as a complication of pharyngeal infection. Bilateral thrombosis can occur but is exceedingly rare. There are no previous case reports of retropharyngeal collection secondary to IJV thrombosis, and we demonstrate our multidisciplinary work-up and subsequent management of this unusual presentation. We present the case of a 48-year-old man who attended the emergency department with painless generalized neck swelling, with no preceding oropharyngeal infection. He was otherwise asymptomatic and flexible nasoendoscopy showed fullness of his posterior pharyngeal wall. A CT scan demonstrated a retropharyngeal collection and bilateral IJV thrombosis secondary to a primary lung malignancy. This case demonstrates the reverse process of Lemierre's syndrome, where bilateral internal jugular vein thrombosis caused a retropharyngeal collection. To our knowledge this is the first reported incidence of this mode of presentation.