A 47-year-old woman had a high fever, a painful neck mass, and face and arm swelling on the left side. Computerized tomography showed thrombosis of the left internal jugular and brachiocephalic veins, mediastinitis, and a left pleural effusion. The patient had no central venous catheter, oropharyngeal infection, or cancer, but did have a history of pregnancy-induced deep venous thrombosis of the leg (four episodes) associated with congenital antithrombin III (ATIII) deficiency. Her symptoms resolved after treatment with intravenous ATIII concentrate, heparin, antibiotics, and warfarin. Internal jugular vein thrombophlebitis is rare but can be life-threatening if not recognized and treated early.
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