Lemierre syndrome is a rare septic thrombophlebitis of the internal jugular vein typically caused by oropharyngeal infection and associated with septic emboli. We report a 50-year-old man with poorly controlled type 2 diabetes who presented with severe oropharyngeal infection complicated by Diabetic Ketoacidosis (DKA), bilateral internal jugular vein thrombosis with extension into the sigmoid and transverse venous sinuses, pulmonary embolism, and bilateral lower-extremity deep venous thromboses. Oropharyngeal cultures grew methicillin-sensitive Staphylococcus Aureus (MSSA) and Serratia marcescens. Management included broad-spectrum antibiotics, metabolic stabilization, and therapeutic anticoagulation following transient thrombocytopenia. This case highlights the expanding spectrum of Lemierre syndrome and the thromboinflammatory interplay between infection and metabolic crisis.
Polymicrobial Lemierre syndrome in patients with metabolic derangements such as diabetic ketoacidosis may present with extensive systemic thrombosis, including intracranial involvement; early recognition and selective use of anticoagulation are critical despite limited consensus guidelines.