Lemierre’s Syndrome Complicated by Cavernous Sinus Thrombosis

This clinical image report describes a 20-year-old woman who presented with headache, diplopia, and right eyelid ptosis one week after an influenza diagnosis. Examination revealed oculomotor nerve palsy with a nonreactive pupil and impaired eye movement. MRI showed bilateral cavernous sinus thrombosis compressing the right oculomotor nerve. CT venography revealed thrombi in both internal jugular veins. Blood cultures identified Fusobacterium necrophorum, confirming Lemierre’s syndrome with the rare complication of cavernous sinus thrombosis. The patient was treated with antibiotics and oral anticoagulation. At two-month follow-up, ptosis had resolved but diplopia persisted; imaging showed complete thrombus resolution. The case highlights the importance of early recognition and imaging in Lemierre’s syndrome with neurologic complications.

This clinical image report describes a 20-year-old woman who presented with headache, diplopia, and right eyelid ptosis one week after an influenza diagnosis. Examination revealed oculomotor nerve palsy with a nonreactive pupil and impaired eye movement. MRI showed bilateral cavernous sinus thrombosis compressing the right oculomotor nerve. CT venography revealed thrombi in both internal jugular veins. Blood cultures identified Fusobacterium necrophorum, confirming Lemierre’s syndrome with the rare complication of cavernous sinus thrombosis. The patient was treated with antibiotics and oral anticoagulation. At two-month follow-up, ptosis had resolved but diplopia persisted; imaging showed complete thrombus resolution. The case highlights the importance of early recognition and imaging in Lemierre’s syndrome with neurologic complications.