Internal Jugular Vein and Transverse Sinus Thrombosis As A Complication of A Chronic Ethmoidal Sinusitis - Internal Jugular Vein and Transverse Sinus Thrombosis As A Complication of A Chronic Ethmoidal Sinusitis - Open Access Pub

Lemierre’s syndrome is rare jugular thrombosis associated with an oropharyngeal infection. The jugular thrombosis is from septic origin. This often happens in young males subjects. We described Lemierre’s syndrome in a 46 year-old man with a chronic ethmoidal sinusitis associated to the left jugular thrombosis extended to the transverse sinus with a partial recanalisation after three months of oral anticoagulant therapy. DOI 10.14302/issn.2470-5020.jnrt-17-1425 Lemierre’s syndrome is characterized by septicemia with anaerobic germ starting with the oropharyngeal infection which can sometimes be asymptomatic1. It was described for the first time in 1936 by Lemierre2. This syndrome affects predominantly healthy adolescents or young adults with a moderate male preponderance. It associates thrombosis of the internal jugular vein with diffuse septic embolisms notably at the pulmonary level. The jugular thrombosis is the main site of this syndrome which sometimes does not present all the other attacks3. It is a rare disease and its incidence has been estimated at 0.8 / 1000000 inhabitants / year in Denmark. The objective was to describe a case of jugular and transverse thrombosis associated with ethmoidal sinusitis. A 46-year-old man was admitted in neurology on June 27, 2016 for left occipito-temporal headache progressively for 2 weeks associated sometimes with nausea and rarely vomiting. He underwent a physical examination of an ophthalmologist and then by a physician of Otorhinolaryngology who had not diagnosed any pathology. On admission, somatic examination was normal. Routine biologic test were normal kidney, hepatic, ionogram, blood count were normal, sedimentation rate was 22 mm /h and C-reactive protein was less normal). The activated cephalin time and the plasmatic homocysteinemia were normal. The activity of protein S and the activated protein C were normal. The chest X-ray and electrocardiogram were normal. The brain ct-scan suspected a left transverse sinus thrombosis. Venous magnetic resonance angiography displayed a left internal jugular vein thrombosis extended to the left transverse sinus associated with a left ethmoidal sinusitis (Figure 1). The cervical doppler was normal. Treatment with low molecular weight heparin was initiated and then replaced with antivitamins K to achieve an international normalized ratio (INR) between 2 and 3 in addition to ofloxacin for 2 weeks and paracetamol. After three months, its remains a partiel jugular thrombosis with persistance of complete transverse sinus thrombosis. Figure 1. Thrombosis of the left