A case of Lemierre’s syndrome complicated by clival osteomyelitis and bilateral cranial nerve XII palsy

Lemierre’s syndrome is characterized by septic thrombophlebitis of the internal jugular (IJ) vein and secondary metastatic manifestations. Secondary manifestations include septic pulmonary emboli to the lungs and central nervous system (CNS) complications, including sigmoid sinus thrombosis, meningitis, and abscesses. Intracranial complications of infection are more common following otogenic infection, especially in children. Osteomyelitis of the skull base and associated cranial nerve palsy is an uncommon presentation. We present the case of an otherwise healthy 18-year-old female with Lemierre’s syndrome complicated by clival osteomyelitis and bilateral cranial nerve XII palsy. The case illustrates the importance of neurological complications of Lemierre’s syndrome, in particular following otogenic infection in younger patients.