A 16-Year old with Lemierre's Syndrome and Multiple Septic Pulmonary Emboli

Introduction: Lemierre’s syndrome, a rare complication of oropharyngeal infections, is caused by infective thrombophlebitis of the internal jugular vein and subsequent development of multisystem septic emboli. Case: A 16-year old male presented with two weeks of fever, myalgia, malaise, nausea/vomiting/diarrhea with weight loss, and a dry cough. He had previously been treated for pneumonia with three days of azithromycin. Chest imaging demonstrated bilateral cavitary lung nodules and blood cultures grew Fusobacterium necrophorum. Right jugular thrombophlebitis was later confirmed. Discussion: Lemierre’s syndrome is most common among previously healthy adolescents. It often presents following mild oropharyngeal infection and may be associated with multiple pulmonary complications including septic emboli, abscesses, necrotizing pneumonia, empyema, pneumothorax, pulmonary embolism, and acute respiratory distress syndrome. Delayed diagnosis may result in life-threatening morbidity or mortality, so pediatric pulmonologists must be aware of this rare disease and maintain a high index of suspicion in cases consistent with Lemierre’s syndrome.