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ABSTRACT
Lemierre's syndrome also termed post-anginal septicemia, is a disease characterized by internal jugular septic thrombophlebitis leading to Fusobacterium septicemia with multiple metastatic foci following an oropharyngeal infection. Diagnosis and management is challenging and can result in fatal consequences due to potential multisystem involvement and multiple complications. We describe here a case of Lemierre's syndrome with multifocal pneumonia, acute renal failure and protracted course of illness over forty days with successful recovery. A brief overview of literature is also presented.
ARTICLE HISTORY
Received 22 December 2016
Accepted 10 August 2017
KEYWORDS
NIL
Background
Lemierre's syndrome is a rare disease that was often fatal in the pre-antibiotic era, with a mortality rate approaching approximately 90%[1]. It used to be named 'a forgotten disease' due to its rarity. There was not a single case reported between 1950's and 1960's but has been more overlooked than forgotten in recent years. According to a systematic review by Karkos et al [2]., its incidence has been steadily increasing since the 1980's, there were six online reported cases from 1980-1990 which rose to 121 from 2000 to 2008. It may be due to the emergence of resistant strains of causative pathogens, more emphasis on the judicious use of antibiotics or simply less clinical suspicion in the minds of physicians.
Case Presentation
A 33-year-old otherwise healthy male presented to emergency room after referral from an urgent care unit after his chest X-ray showed multifocal pneumonia. His symptoms started with high grade-fever and rigors for the last 9 days. He later developed sore throat, difficulty swallowing, productive cough and progressive dyspnea. He denied any sick contacts, romantic relationships, recent travel, tuberculosis exposure, recent dental procedure or exposure to animals.
On presentation, his vitals included a temperature of 104°F, pulse-140/min, blood pressure -104/ 53 mmHg, respiratory rate-33/min and oxygen saturation-89% on ambient air.
On physical examination, he appeared toxic and scleral icterus was noticed. The oropharynx examination showed right tonsillar swelling with erythema but without exudates. A firm immobile non-tender right submandibular swelling was present. No tongue swelling, dental caries/abscesses were identified. Axillary and cervical lymph nodes were not appreciated. No skin rash, joint swelling, needle or track marks were noticed. Chest examination showed bilateral rhonchi. Central nervous, cardiovascular and gastrointestinal systems were...