Background: Lemierre's syndrome is a rare condition involving septic thrombophlebitis of the internal jugular vein secondary to an acute oropharyngeal infection. The low incidence and prevalence of Lemierre's syndrome contribute to the many controversies pertaining to its therapeutic management, one of which is the use of anticoagulation for associated internal jugular vein thrombus.
Case description: A previously healthy 5-year-old male admitted with left internal jugular vein thrombosis associated with Lemierre's syndrome was placed on appropriate antibiotics and anticoagulation therapy with enoxaparin. 3 weeks post-discharge, patient was found to be in good condition and a magnetic resonance angiography showed persistent occlusion of the left internal jugular vein.
Conclusion: Anticoagulation therapy for internal jugular vein thrombosis associated with Lemierre's syndrome remains a controversy. In the absence of any contraindication or presumed risk, anticoagulation therapy should be considered in high risk patients.