LAUSR

Introduction: Lemierre’s Syndrome (LS) is an acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein (JV) and distant septic emboli. Formerly called “the forgotten disease,” it is a rare and potentially fatal disease. Description: A 29-year-old female presented to an urgent care center with sore throat, shortness of breath and left shoulder pain. She was prescribed azithromycin for pneumonia. About four days later, she presented to the emergency department with progressive worsening of the same symptoms. Her vitals revealed she was febrile, tachycardic, tachypneic, hypoxic and hypotensive. Patient was in respiratory distress and had a red, hot and tender swelling on her left shoulder. The patient was admitted to the intensive care unit (ICU). Lab-work revealed a leukocyte count of 32,000 cells/μl, with predominantly neutrophils. Computed topography of neck and chest showed multiple loculated abscesses of the left shoulder, retro-clavicular soft tissue, right peritonsillar region, thrombosis of a branch of right external JV and multiple bilateral septic emboli to the lungs. Due to respiratory distress and septic shock, she had to be intubated and was started on vasopressors. She was started on clindamycin and ampicillin-sulbactam. She underwent drainage of the left shoulder abscess. Cultures from blood and abscess both grew Fusobacterium nucleatum. Patient had a complicated course in the ICU, with involvement of multiple subspecialties. Eventually, the patient clinically improved and was transferred to medicine floor. Discussion: LS usually involves internal JV but can involve the external JV or its branches. Although pulmonary septic emboli are common, rarely musculoskeletal abscesses can occur as an unusual presenting symptom. Point-of-care bedside ultrasound can help visualize the internal JV for signs of thrombus formation. With the caution in using antibiotics for uncomplicated sore throat in recent times, the incidence of LS has started to rise. Our case highlights that LS requires prompt diagnosis and management by a multidisciplinary team to prevent progressive decline. Clinicians should consider this diagnosis in young patients with an unresolving sore throat, persistent fever, as it can be fatal if undiagnosed.