Patients with Lemierre syndrome have a high risk of new thromboembolic complications, clinical sequelae and death: an analysis of 712 cases

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Background: Lemierre syndrome is characterized by head/neck vein thrombosis and septic embolism usually complicating an acute oropharyngeal bacterial infection in adolescents and young adults. We described the course of Lemierre syndrome in the contemporary era. Methods: In our individual-level analysis of 712 patients (2000–2017), we included cases described as Lemierre syndrome if these criteria were met: (i) primary site of bacterial infection in the head/neck; (ii) objectively confirmed local thrombotic complications or septic embolism. The study outcomes were new or recurrent venous thromboembolism or peripheral septic lesions, major bleeding, all-cause death and clinical sequelae. Results: The median age was 21 (Q1–Q3: 17–33) years, and 295 (41%) were female. At diagnosis, acute thrombosis of head/neck veins was detected in 597 (84%) patients, septic embolism in 582 (82%) and both in 468 (80%). After diagnosis and during in-hospital follow-up, new venous thromboembolism occurred in 34 (5.2%, 95% CI 3.8–7.2%) patients, new peripheral septic lesions became evident in 76 (11.7%; 9.4–14.3%). The rate of either was lower in patients who received anticoagulation (OR: 0.59; 0.36–0.94), higher in those with initial intracranial involvement (OR: 2.35; 1.45–3.80). Major bleeding occurred in 19 patients (2.9%; 1.9–4.5%), and 26 died (4.0%; 2.7–5.8%). Clinical sequelae were reported in 65 (10.4%, 8.2–13.0%) individuals, often consisting of cranial nerve palsy (n = 24) and orthopaedic limitations (n = 19). Conclusions: Patients with Lemierre syndrome were characterized by a substantial risk of new thromboembolic complications and death. This risk was higher in the presence of initial intracranial involvement. One-tenth of survivors suffered major clinical sequelae.


  • Luca Valerio
  • Federica Zane
  • Clara Sacco
  • Serena Granziera
  • Tommaso Nicoletti
  • Mariaconcetta Russo
  • Gabriele Corsi
  • Karin Holm
  • Michel André Hotz
  • Christian Righini
  • Petros D. Karkos
  • Seyed Hamidreza Mahmoudpour
  • Nils Kucher
  • Peter Verhamme
  • Marcello Di Nisio
  • Robert M. Centor
  • Stavros V. Konstantinides
  • Alessandro Pecci
  • Stefano Barco
External organisations
  • Universitätsmedizin Mainz
  • Humanitas Research Hospital
  • Policlinico Universitario Agostino Gemelli
  • University of Bern
  • Grenoble University Hospital
  • Aristotle University of Thessaloniki
  • University Hospital of Zurich
  • University Hospitals Leuven
  • University of Chieti-Pescara
  • Democritus University of Thrace
  • Policlinico San Matteo Pavia Fondazione
  • Hospital of Sondrio
  • Fatebenefratelli Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems


  • anticoagulation, Fusobacterium necrophorum, Lemierre syndrome, pulmonary embolism, septic embolism, venous thromboembolism
Original languageEnglish
Pages (from-to)325-339
JournalJournal of Internal Medicine
Issue number3
Early online date2020
Publication statusPublished - 2021
Publication categoryResearch