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

Thematic areas: Infectious disease, microbiology, respiratory medicine. We report a case of a syndrome first described by French bacteriologist Andre Lemierre nearly one hundred years ago1. A young woman presented with fever, chest pain and oligoarthritis. Admission investigations revealed thrombocytopenia, cavitating pneumonia and an internal jugular vein thrombus. Blood cultures were positive for F. necrophorum and S. constellatus. Respiratory failure developed within 48 hrs and was managed with high flow nasal oxygen in a critical care setting. Discussed are the investigation findings leading to diagnosis, as well as the antimicrobial and anticoagulation management strategies. Lemierre's syndrome is rarely encountered by generalist physicians. It is a life-threatening, systemic complication of, in most patients, pharyngitis or tonsillitis2. It should be considered in young adult patients with a sepsis-type presentation and cavitating lung lesions or multiple pulmonary emboli. Thoracic and neck vessel imaging is of critical diagnostic value in suspected patients, particularly in the absence of typical clinical findings. A good outcome can be expected with prompt diagnosis and appropriate anaerobic cover. However, conclusive evidence is needed to provide guidance on the role of anticoagulation in Lemierre's syndrome.