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

•Lemierre's syndrome is a life-threatening, systemic complication of, in most patients, pharyngitis or tonsillitis.•It should also 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 an identified bacteraemia or prior to sensitivity results.•The relationship between Fusobacterium infection and thrombocytopenia remains unclear, and conclusive evidence is needed to provide guidance on the role of anticoagulation in Lemierre's syndrome.•Full recovery can be anticipated following diagnosis and successful antimicrobial management. 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.