Lemierre syndrome with blepharoptosis.

A 51-year-old woman was hospitalized with a high fever, occipital pain, blepharoptosis, and trismus. Enhanced CT showed thrombophlebitis of her left cavernous sinus, maxillary vein, and multiple pulmonary nodular lesions. (18)F-FDG PET/CT showed significant uptakes in the same lesions. Streptococcus constellatus was detected in her blood. Therefore, she was diagnosed as a Lemierre syndrome variant. After administration of antibiotics, all symptoms, inflammatory reactions, and thrombi disappeared. Since Lemierre syndrome has life-threatening potential, early diagnosis and initiation of appropriate therapy are important. In this case, (18)F-FDG PET/CT was useful to detect the focus and extent of infection.