lemierre 's syndrome is rare and to our best knowledge never before described after gynecological surgery ; however , it should be considered in case of rapidly developing respiratory problems after even simple surgical procedures . these bacteria are common in the oropharyngeal tract , and the syndrome often originates here . the patient usually presents with sore throat and fever , later complicated by pulmonary infarcts , respiratory dysfunction , and often also arthritic manifestations . without proper antibiotic treatment , the syndrome is rare , with 3,6 annual cases per million inhabitants in denmark , the incidence being highest between the ages of 14 and 24 years . in this article , we present a case of lemierre 's syndrome after evacuation of the uterus in an otherwise healthy young woman . a 26-year - old otherwise healthy woman was referred to the department due to rising levels of human chorionic gonadotropin and intermittent vaginal bleeding 6 weeks after a legal medical abortion . a new vaginal ultrasound revealed placental remnants in the uterus , and a surgical evacuation of the uterus was carried out . the operation went without complications , and the patient was discharged later on the day of the surgery . the following day , the patient was readmitted due to a temperature of 39.5c and abdominal pain and , suspecting severe endometritis , metronidazole , benzylpenicillin , and gentamicin were administered intravenously . within 24 h , the patient deteriorated , saturation fell to 90% and respiratory rate rose to around 40 breaths per minute even though oxygen was given by mask . temperature peaked at 40.7c even though antibiotics was administered intravenously , c - reactive protein rose to around 300 mg / l and leukocytes to around 15  10/l . the patient was moved to the intensive care unit and intubated . due to the rapid deterioration of respiratory function , a ct scan was performed showing thrombophlebitis of the internal jugular vein and hepatomegaly , and the patient was diagnosed with lemierre 's syndrome . benzylpenicillin and gentamicin were discontinued , and instead tazocin and clindamycin were administered in combination with metronidazole . after 2 weeks of respiratory support and antibiotics at the intensive care unit and another week in a standard hospital ward , the patient had recovered and was discharged . at no point had the patient presented with symptoms from the oropharyngeal tract . blood cultures showed infection with f. necrophorum , which were also cultivated from the patient 's cervix , and it was concluded that the infection originated from the cervix . infection following surgical evacuation of the uterus is common , occurring after 57% of all evacuations . common infective agents include neisseria gonorrhoea , chlamydia thracomatis , gardnerella vaginalis , and a wide variety of anaerobic bacteria . fusobacterium necrophorum is a common finding in the urogenital tract , however , normally not a pathogenic one and we have found only one previous report of lemierre 's syndrome caused by f. necrophorum originating from the urogenital tract . it is not known how infection with f. necrophorum causes septic thrombophlebitis of the internal jugular vein . for lemierre 's syndrome originating in the oropharyngeal tract , both hematogenous spread ; local spread through the oropharyngeal lymphatic system and spread through abscesses in the loose connecting tissue close to the internal jugular vein has been suggested . our case supports the theory of hematogenous spread , as the patient never had symptoms from the oropharyngeal tract , and as f. necrophorum was cultivated from the patient 's cervix and not from her oropharyngeal tract . once infection reached the internal jugular vein , it will spread hematogenously throughout the body , causing a variety of complications , that is , pulmonary embolisms , arthritis , or abscesses . early diagnosis and correct treatment is crucial to complete recovery . the syndrome is best diagnosed through a ct of the neck and lungs , which will show thrombophlebitis of the internal jugular vein . antibiotic treatment should be given upon suspicion , and should include metronidazole and beta - lactamase inhibitor . to prevent thromboembolic complications , anticoagulation should be considered . other efforts , that is , respiratory support or surgical drainage of abscesses are often necessary .
key clinical messageeven minor surgical interventions can have serious complications . 
 lemierre 's syndrome is rare and to our best knowledge never before described after gynecological surgery ; however , it should be considered in case of rapidly developing respiratory problems after even simple surgical procedures .