Thrombophlébite Septique Jugulaire en Réanimation Post-Intubation Prolongée à Yaoundé : Un Syndrome de Lemierre Iatrogène: Septic Jugular Thrombophlebitis in Intensive Care Following Prolonged Intubation in Yaoundé: An Iatrogenic Lemierre Syndrome

Abstract

Lemierre syndrome is a rare and serious septic condition characterised by septic thrombophlebitis of the internal jugular vein, typically occurring in the context of a recent oropharyngeal infection. Without early appropriate treatment, it can be life-threatening. We report the case of a 73-year-old female patient hospitalised in intensive care for a haemorrhagic stroke, whose course was marked by prolonged invasive ventilation, persistent sepsis and the secondary onset of cervicofacial oedema. Cervical Doppler ultrasound revealed bilateral thrombosis of the internal jugular veins. Several nosocomial organisms were isolated from the invasive devices. In the absence of any documented initial ENT infection, a diagnosis of Lemierre syndrome was considered in an atypical form, possibly associated with care, favoured by repeated intubations, impaired local defences and frailty. Despite appropriate management, the outcome was unfavourable. The patient's condition deteriorated, marked by recurrent seizures, persistent hypoxaemia despite 100% inspired oxygen, and haemodynamic instability refractory to vascular filling and vasopressors. The patient died on the sixty-first day of hospitalisation (D61) from multiple organ failure. This case highlights the importance of considering Lemierre syndrome in intensive care in any case of unexplained sepsis and cervical signs, even outside the classic post-angina context.