{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T05:55:19Z","timestamp":1793166919456,"version":"4.5.0"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Lemierre syndrome is a rare but potentially life-threatening condition, characterized by septic thrombophlebitis of the internal jugular vein and classically following an oropharyngeal infection. Although traditionally associated with young, otherwise healthy adults and\n                      <jats:italic>Fusobacterium necrophorum<\/jats:italic>\n                      infection, contemporary reports increasingly recognize a broader clinical spectrum, including culture-negative and Lemierre-like presentations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      We describe four patients with classic Lemierre syndrome or Lemierre-like septic internal jugular vein thrombophlebitis managed between 2012 and 2023 at a tertiary care center in Saudi Arabia. Patients ranged in age from 31 to 72\u2005years and had diverse underlying comorbidities. All presented with unilateral neck pain or swelling, and imaging confirmed internal jugular vein thrombosis in all four cases, including one with intracranial extension into the sigmoid and transverse venous sinuses. Deep neck abscesses were identified in three patients. Blood cultures were negative in all cases, while an abscess culture from one patient with poorly controlled diabetes mellitus yielded\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      . Antimicrobial therapy ranged from 3 to 6\u2005weeks. Anticoagulation strategies varied according to thrombus extent, bleeding risk, comorbidities, and overall clinical presentation. All patients experienced favorable clinical outcomes, with follow-up imaging demonstrating thrombus stability, partial recanalization, or complete resolution.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case series illustrates the broader clinical spectrum of septic internal jugular vein thrombophlebitis, encompassing both classic Lemierre syndrome and Lemierre-like presentations. The cases demonstrate that diagnosis may rely predominantly on compatible clinical and radiological findings despite negative blood cultures. Management should be individualized according to disease severity, thrombus extent, bleeding risk, and patient-specific factors, particularly given the limited evidence guiding anticoagulation in this setting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1821698","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:43:28Z","timestamp":1790138608000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Expanding the clinical spectrum of Lemierre syndrome and Lemierre-like septic internal jugular vein thrombophlebitis: a four-case series"],"prefix":"10.3389","volume":"13","author":[{"given":"Abdullah","family":"Alyousef","sequence":"first","affiliation":[{"name":"Internal Medicine and Thrombosis, Medical Specialties Department, King Fahad Medical City, Riyadh Second Health Cluster","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yacoub","family":"Abuzied","sequence":"additional","affiliation":[{"name":"Department of Nursing, Rehabilitation Hospital, King Fahad Medical City, Riyadh Second Health Cluster","place":["Riyadh, Saudi Arabia"]},{"name":"Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia","place":["Serdang, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Alhassoun","sequence":"additional","affiliation":[{"name":"Internal Medicine and Thrombosis, Medical Specialties Department, King Fahad Medical City, Riyadh Second Health Cluster","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lama","family":"Alfehaid","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences","place":["Riyadh, Saudi Arabia"]},{"name":"Pharmaceutical Care Department, King Abdulaziz Medical City","place":["Riyadh, Saudi Arabia"]},{"name":"King Abdullah International Medical Research Center","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"AlSheef","sequence":"additional","affiliation":[{"name":"Internal Medicine and Thrombosis, Medical Specialties Department, King Fahad Medical City, Riyadh Second Health Cluster","place":["Riyadh, Saudi Arabia"]},{"name":"College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e43685","DOI":"10.7759\/cureus.43685","article-title":"Lemierre's syndrome in the 21st century: a literature review","volume":"15","author":"Tiwari","year":"2023","journal-title":"Cureus"},{"key":"B2","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1128\/CMR.00011-07","article-title":"Human infection with Fusobacterium necrophorum (necrobacillosis), with a focus on Lemierre's syndrome","volume":"20","author":"Riordan","year":"2007","journal-title":"Clin Microbiol Rev"},{"key":"B3","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1111\/j.1469-0691.2007.01719.x","article-title":"Detection of Fusobacterium necrophorum subsp. Funduliforme in tonsillitis in young adults by real-time PCR","volume":"13","author":"Jensen","year":"2007","journal-title":"Clin Microbiol Infect"},{"key":"B4","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1186\/1752-1947-6-97","article-title":"Lemierre's syndrome due to Klebsiella pneumoniae in a 63-year-old man with diabetes: a case report","volume":"6","author":"Garbati","year":"2012","journal-title":"J Med Case Rep"},{"key":"B5","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1016\/j.jmii.2020.03.027","article-title":"Lemierre's syndrome: a forgotten and re-emerging infection","volume":"53","author":"Lee","year":"2020","journal-title":"J Microbiol Immunol Infect"},{"key":"B6","doi-asserted-by":"publisher","first-page":"116123","DOI":"10.1016\/j.diagmicrobio.2023.116123","article-title":"Lemierre's syndrome: varying pathogens, clinical presentations and complications","volume":"108","author":"Lampejo","year":"2024","journal-title":"Diagn Microbiol Infect Dis"},{"key":"B7","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1186\/s12959-026-00889-y","article-title":"Anticoagulation therapy for Lemierre syndrome: a comprehensive review and individual participant data analysis","volume":"24","author":"Tsuda","year":"2026","journal-title":"Thromb J"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e379","DOI":"10.1055\/s-0039-3402433","article-title":"Lemierre syndrome: a meta-analysis","volume":"24","author":"Gore","year":"2020","journal-title":"Int Arch Otorhinolaryngol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"102165","DOI":"10.1016\/j.anaerobe.2020.102165","article-title":"Fusobacterium bloodstream infections: a literature review and hospital-based case series","volume":"62","author":"Almohaya","year":"2020","journal-title":"Anaerobe"},{"key":"B10","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1016\/S0140-6736(00)57035-4","article-title":"On certain septicaemias due to anaerobic organisms","volume":"227","author":"Lemierre","year":"1936","journal-title":"Lancet"},{"key":"B11","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1007\/s10096-008-0496-4","article-title":"Lemierre's syndrome and other disseminated Fusobacterium necrophorum infections in Denmark: a prospective epidemiological and clinical survey","volume":"27","author":"Hagelskjaer Kristensen","year":"2008","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1089.e7","DOI":"10.1016\/j.cmi.2019.12.002","article-title":"Invasive infections with Fusobacterium necrophorum including Lemierre's syndrome: an 8-year Swedish nationwide retrospective study","volume":"26","author":"Nygren","year":"2020","journal-title":"Clin Microbiol Infect"},{"key":"B13","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1111\/joim.13114","article-title":"Patients with Lemierre syndrome have a high risk of new thromboembolic complications, clinical sequelae and death: an analysis of 712 cases","volume":"289","author":"Valerio","year":"2021","journal-title":"J Intern Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"rjx210","DOI":"10.1093\/jscr\/rjx210","article-title":"Lemierre syndrome: a diagnostic dilemma in paediatric patients","volume":"2017","author":"Rafati","year":"2017","journal-title":"J Surg Case Rep"},{"key":"B15","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.jvscit.2019.11.007","article-title":"Lemierre's syndrome caused by Streptococcus pyogenes in an elderly woman","volume":"6","author":"Siddique","year":"2020","journal-title":"J Vasc Surg Cases Innov Tech"},{"key":"B16","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1097\/00019048-199608000-00010","article-title":"A case of Lemierre's syndrome due to Klebsiella pneumoniae","volume":"5","author":"Bhgat","year":"1996","journal-title":"Infect Dis Clin Pract"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1552","DOI":"10.1002\/lary.20542","article-title":"Lemierre's syndrome: a systematic review","volume":"119","author":"Karkos","year":"2009","journal-title":"Laryngoscope"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1821698\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:43:38Z","timestamp":1790138618000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1821698\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,23]]},"references-count":17,"alternative-id":["10.3389\/fmed.2026.1821698"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1821698","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,23]]},"article-number":"1821698"}}