Acute Respiratory Distress Syndrome in Lemierre's Syndrome

Lemierre's syndrome: A rare cause of septic emboli in a young adult

Lemierre's syndrome is a deadly disease that is often over-looked due to its rarity. In this report, a 21-year-old Caucasian woman, with no past medical history, presented to a 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, she underwent an extensive work-up investigating other etiologies prior to receiving a correct diagnosis and adequate treatment. This case demonstrates how a thorough history and physical exam can aid Radiologists in expediting the diagnostic process for a potentially fatal disease. Although rare, a history of pharyngitis and neck pain in a septic patient should help Radiologists to exclude more common etiologies which, through their investigations, prolong life-saving treatment.

A case of Lemierre's syndrome with septic shock and complicated parapneumonic effusions requiring intrapleural fibrinolysis

Lemierre's syndrome is a septic thrombophlebitis of the internal jugular vein, which can lead to severe systemic illness. We report a case of an otherwise healthy 26-year-old man who suffered from pharyngitis followed by septic shock requiring intubation and vasopressor support from Fusobacterium necrophorum bacteremia. The septic emboli to his lungs caused complicated bilateral parapneumonic effusions, which recurred after initial drainage. He required bilateral chest tubes and intrapleural tPA to successfully drain his effusions. His fever curve and overall condition improved with the resolution of his effusions and after a 33-day hospitalization, he recovered without significant disability. The severity of his illness and difficult to manage complicated parapneumonic effusions were the unique facets of this case. Using an evidence-based approach of tPA and DNase for complicated parapneumonic effusions in Lemierre's syndrome can be safe and effective.