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