A50-27 Facial Vein Variant of Lemierre Syndrome Due to Streptococcus Pyogenes

Abstract Lemierre Syndrome is a rare condition that refers to septic thrombophlebitis of the internal jugular vein. Due to the rarity of the condition, no systematic study of the pathophysiology, management, and outcomes of Lemierre syndrome has been performed to date. The case presented is of a 67 y.o. male with no past medical history, who presented to the ED with worsening right-sided jaw swelling. He reported flulike symptoms that had started about a week ago and resolved after taking ibuprofen. Shortly thereafter, he started experiencing worsening jaw swelling that had progressed down to his neck. Otherwise, he denied swallowing liquids or solids, ear pain, difficulty hearing, shortness of breath, and cough. Upon arrival to the ED, patient was afebrile, normotensive (125/62), HR 118, RR 24, and had oxygen saturation of 95% on room air. Physical examination findings showed poor dentition, missing teeth, some exudate on right lower molar, normal appearing tonsils, and firm swelling on right side of neck at submental and right submandibular area. Lab work was notable for leukocytosis of 27.5, elevated ESR 83, CRP 32.6 and lactic acid 2.7. CT soft tissue neck with contrast demonstrated asymmetrically enlarged right submandibular gland with associated reactive cervical lymphadenopathy, right mandibular soft tissue swelling and 4mm acute thrombosis of the right facial vein representing thrombophlebitis. Blood cultures were positive for Group A Strep pyogenes. Patient was diagnosed with facial vein variant of Lemierre Syndrome. ENT was consulted and recommended no surgical interventions as it was deemed his acute right facial vein thrombosis is a sequela of septic emboli and is not surgical in nature. Additionally, infectious disease was also consulted and recommended course of antibiotics for total of 10 days. Lastly, echocardiogram did not reveal valvular involvement. Throughout hospitalization, patient continued to show slow but continuous improvement of facial swelling. He was able to eat food without pain or discomfort. Although septic thrombophlebitis of the internal jugular vein remains the most common definition of Lemierre Syndrome, some studies have shown to include septic thrombophlebitis of facial vein as a variant of Lemierre syndrome. To date, it remains challenging to treat similar cases to the one presented in this case as septic thrombophlebitis of facial vein remains a rare and uncommon presentation of Lemierre syndrome. Therefore, the aim of this case report is to highlight the clinical variance as well as difficulty with diagnosis. This abstract is funded by: None