It all started with a sore throat: Polymicrobial septicaemia, cavitating lung lesions and severe thrombocytopenia

Abstract

We report a case of a syndrome first described by French bacteriologist André Lemierre nearly 100 years ago. A young woman presented with fever, chest pain and arthralgia. Admission investigations revealed thrombocytopenia, cavitating pneumonia and an internal jugular vein thrombus. Blood cultures were positive for Fusobacterium necrophorum and Streptococcus constellatus. Respiratory failure developed within 48 h and was managed with high-flow nasal oxygen in a critical care setting. The investigation findings leading to diagnosis, as well as the antimicrobial and anticoagulation management strategies, are discussed. Lemierre's syndrome is rarely encountered by non-specialists, but a good outcome can be expected with prompt diagnosis and treatment.

Keywords

• Lemierre's syndrome
• Fusobacterium necrophorum
• Thrombophlebitis of the internal jugular vein
• Cavitating lung lesions
• Thrombocytopenia