Discussion
In our patient, the period from the preceding infection to the
appearance of Lemierre’s syndrome symptoms was short; thus, we
understand that an extremely intense condition manifested in our
patient.
Fusobacterium necrophorum , a gram-negative anaerobic bacteria, is
the causative agent of Lemierre’s syndrome in most cases. The same
bacterium was identified in our patient. The most common organ affected
by septic embolism is the lungs, followed by joints such as hip joints,
knees, and shoulders; skin and soft tissue; and the
endocardium.1,2In a systematic review in 2020, Dasari
et al.3 found only 27 cases of ophthalmologic
complications with Lemierre’s disease reported between 2009 and
2019.4 Among these 27 cases, the most common
ophthalmologic complications were cranial nerve III/IV/VI palsy and
oculomotor disorder due to external ophthalmoplegia. Abducens nerve
palsy was noted in 12 (44.44%) cases. Cavernous sinus thrombosis was
observed in 19 (70.37%) cases. The next most common symptoms were
blepharoptosis (9 cases, 33.33%) and visual impairment (8 cases,
29.63%). Of the three patients with visual impairment, the condition of
two patients recovered to some extent, but that of the remaining one
patient did not.3
Ophthalmologic complications of Lemierre syndrome may be caused by
inflammation spreading from the cavernous sinus to the nerves and
muscles. The cavernous sinus receives blood from various veins such as
the superior orbital vein, intracranial vein, and parietal sinus. These
extensive connections cause retrograde septic embolism from the internal
jugular vein, resulting in cavernous sinus
thrombosis.3,4