see also:

• sepsis / septicaemia
• sore throats in adults

• a rare syndrome caused by the anaerobe F. necrophorum secondary to oropharyngeal infections mainly in 18-35 yr olds
• infection extends from the pharynx into the parapharyngeal spaces of the neck and then causes septic thrombophlebitis of the internal jugular vein
• infection may also extend into cervical veins and the mediastinal structures
• once infection has invaded the cervical veins, septic emboli occur - 85% to the lungs, but other organs, bones and meninges may become septic from the emboli

• preceding oropharyngeal infection
• unilateral neck tenderness and swelling
• 25-45% have a “cord sign” - palpable swelling and tenderness at the mandibular angle which suggests thrombophlebitis of the internal jugular vein
• 7% develop septic shock

• high inflammatory markers (WCC, CRP) with substantively raised D-Dimer help support the clinical diagnosis
• US can be useful but has lower sensitivity than CT with contrast or MRV due to low echogenicity of fresh clots combined with anatomic constraints of the lower neck
• CT scan with venous phase contrast
• MRV of the neck has higher sensitivity than CT with contrast
• Blood cultures grow Fusobacterium in ~70% of cases but take 2-7 days

• IV antibiotics
  • usually start with a beta-lactamase-resistant beta-lactam antibiotic then adjust as per culture results
• generally requires a 6 week course of antibiotics to ensure adequate penetration of fibrin clots
• surgical drainage of any abscesses
• advanced infection may require ICU
  • mortality is 5-18% in these cases despite antibiotics and surgical drainage
  • septic emboli and end-organ effects can result in long-term morbidity
• possible indications for anticoagulation:
  • thrombus extends into the cerebral sinuses
  • large or bilateral clot burden
  • patient fails to improve in the first 72 hours with appropriate antibiotic and/or surgical therapy.