Lemierre’s Syndrome with Neck Phlegmon Following Otitis Media in A Patient with ‎Rheumatic Heart Disease Disease: A Case Report from Ethiopia

Introduction: Lemierre’s syndrome is a rare septic thrombophlebitis of the internal ‎jugular vein, classically following oropharyngeal infection. Once common in the pre-‎antibiotic era, it is now termed the “forgotten disease.” Otitis media as a preceding ‎infection is exceptional.‎ Case Presentation: A 33-year-old Ethiopian woman with rheumatic heart disease ‎presented with fever, sore throat, dysphagia, and right-sided neck swelling after ‎untreated otitis media. Ultrasound confirmed a right neck abscess with internal jugular ‎vein thrombosis. She was treated with intravenous ceftriaxone and metronidazole, ‎underwent surgical drainage, and was anticoagulated. She improved after two weeks of ‎hospital stay and was discharged on oral antibiotics and warfarin.‎ Discussion: Lemierre’s syndrome typically follows pharyngeal infections. Diagnosis ‎requires imaging, with CT being the gold standard, but ultrasound remains essential ‎where resources are limited. Prolonged antibiotics are the mainstay, and the role of ‎anticoagulation is debated.‎ Conclusion: This case highlights the importance of maintaining suspicion for ‎Lemierre’s syndrome in patients with head and neck infections, even when the source is ‎otitis media, particularly in resource-limited regions. It sends a message to policy ‎makers. They need to improve diagnostic imaging, like CT scans, in resource-limited ‎settings. It also underscores the need to have guidelines or protocols for Lemierre’s ‎syndrome diagnosis and management, especially on the use of anticoagulants‎.