Discussion: Spontaneous internal jugular vein thrombosis (IJVT) is rare, occurring in less than 1 in 25,000 individuals annually. It is most commonly associated with use of central venous access devices (CVADs), but can also be caused by deep neck infections, intravenous drug abuse, trauma, or hypercoagulability associated with malignancy. Lemierre’s syndrome is rare, with the incidence estimated to be 1 per 1,000,000, and is most commonly caused by a peritonsillar or tonsillar infection with anaerobic bacteria. 83% of cases present with fever and sore throat, and 78% have leukocytosis. On the other hand, malignancy in general has a much higher incidence than Lemierre’s syndrome, with testicular cancer alone having an incidence of 4.84 per 100,000. Malignancy increases the risk of VTE, with a 400% increase in risk of DVT or PE. In isolated spontaneous IJVT, up to 10.8% of cases will be diagnosed with a malignancy within one year. Our decision for anticoagulation in this patient as part of treatment for a suspected septic thrombophlebitis or Lemierre’s was controversial, as was our decision to pursue further hypercoagulability work-up; however, due his atypical presentation of a rather rare disease (Lemierre’s), our concern for malignancy-associated hypercoagulability led us to place this patient on anticoagulation and ultimately down a path of the definitive diagnosis and treatment
Conclusions: In cases of IJVT without evidence of CVADs, IV drug use, trauma or infection, screening for malignancy should be considered to provide an accurate diagnosis and timely treatment.
To cite this abstract:Miller, T; Jodon, G; Zheng, C . LEMIERRE’S? I BEG TO DIFFER, LET’S CALL IT PSEUDO-LEMIERRE’S. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 598. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/lemierres-i-beg-to-differ-lets-call-it-pseudo-lemierres/. Accessed September 20, 2019.