台耳醫誌

Lemierre syndrome is a rare and potentially fatal complication of oropharyngeal bacterial infections, primarily caused by Fusobacterium necrophorum. This report presents an atypical case of Lemierre syndrome in a 29-year-old male who initially exhibited symptoms of acute cholangitis and cholelithiasis without the typical oropharyngeal manifestations. The patient was admitted with right upper quadrant pain, diarrhea, vomiting, fever, and chills. Following endoscopic retrograde cholangiopancreatography (ERCP), he developed left neck pain and swelling. Laboratory findings revealed obstructive jaundice and leukocytosis. Imaging studies demonstrated gallbladder wall thickening with gallstones, left internal jugular vein thrombosis, inflammatory lymphadenopathy, and pulmonary septic emboli. Head and neck ultrasound confirmed a hyperechoic thrombus in the left internal jugular vein. Treatment included Levofloxacin, Tapimycin(Piperacillin and Tazobactam), and Metronidazole. Blood cultures confirmed Fusobacterium necrophorum, establishing the diagnosis of Lemierre syndrome. The patient’s symptoms resolved after treatment, and he was discharged with oral antibiotics and scheduled follow-up. This case underscores the importance of considering Lemierre syndrome in patients with unexplained fever and neck symptoms, particularly following invasive procedures, even in the absence of typical oropharyngeal signs. Early diagnosis through imaging and microbiological evaluation is crucial to initiate effective treatment and improve outcomes. (J Taiwan Otolaryngol Head Neck Surg 2026; 60:37-41)