Lemierre's syndrome: A rare cause of septic emboli in young
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21-year-old woman, with no past medical history, presented to walk-in in clinic and twice to an emergency department between January 30th, 2020 and February 5th, 2020 for progression of fevers, sore throat, neck, and pleuritic chest pain. The patient was sent home her first 2 visits with an incorrect diagnosis. Despite having a presentation consistent with Lemierre's syndrome, on her third visit, a Chest X-Ray was conducted on the day of admission that showed multifocal bilateral lung opacities. This was followed up with a CT Chest where the report read bilateral peripheral nodular opacifications consistent with septic emboli.

The patient was placed on broad spectrum antibiotic coverage with Vancomycin and Zosyn. blood culture grew the gram-negative anaerobe, porphyromonas asaccharolytica. This study showed a thrombus in the internal jugular vein that was confirmed with a CT of the neck with contrast . With the bacteria and source identified, the patient had a peripherally inserted central line implemented and was started on Ertapenem 1 gram every 24 hours and was discharged home. The patient continued on this regimen until March 6th at which time she reported a full recovery. This case demonstrates how a thorough history and physical exam can aid Radiologists in expediting the diagnostic process for a potentially fatal disease.

Lemierre's syndrome occurs when a preceding pharyngitis allows gram negative anaerobes to invade the parapharyngeal space and seed the internal jugular vein. The resulting septic thrombus then serves as a source of bacterial emboli that usually manifest in the lungs. Victims will present febrile, in respiratory distress with neck and pleuritic chest pain. Credit for the characterization of this disease is given to French Bacteriologist, André Lemierre, who published a case series consisting of 20 patients, reporting a 90% mortality back in 1936. Despite impressive advancements in medicinal sciences, the syndrome still boasts a mortality rate that approaches 15%. Interestingly, Lemierre's syndrome tends to occur in healthy, younger individuals between the ages of 15 and 30 years and has a prevalence of 3-4 cases per million individuals.

Source: https://www.sciencedirect.com/science/article/pii/S1930043320301059?dgcid=rss_sd_all
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