FP-3. Lemierre disease: case report.

A 19-year-old Caucasian male was admitted on the general medicine floor observation unit for a 1 1/2 week history of malaise, sore throat, low grade fever, nausea, and vomiting X2, negative rapid strep. Initial vitals were HR 102, BP 110/75, Temp 100.3[degrees]F, presumed diagnosis of dehydration due to viral syndrome. Chest x-rays showed pattern of an atypical pneumonia. The patient was placed on empirical therapy, and cultures were drawn; the patient showed localized erythematous non-raised patchy rash over his left wrist (not appreciated on initial physical) over the course of 24 hours. Cultures reported at 48 hours showed growing of Fusobacterium necrophorum on tubes 1 and 2 from his blood; antibiotics were then changed, anti-thrombolytic therapy was instituted; bilateral pulmonary embolism was diagnosed on spiral CT, jugular thrombosis was also reported from the work-up. The patient was discharged home after 12 days of hospitalization, which included 3 days in the ICU, with 3 more weeks of IV antibiotics, anti-thrombolytics and outpatient clinic visits. Lemierre syndrome develops after pharyngeal infection secondary to the virulent nature of the Gram-negative anaerobe F necrophorum, part of the normal flora of the oropharynx, female genital tract, and alimentary canal. Previously healthy, young patients present with high fevers, rigors, swelling and tenderness at the angle of the mandible or sternocleidomastoid, sudden thoracic pain, dyspnea, arthritic pain, and often icterus. This rare syndrome consists of thrombophlebitis of the internal jugular vein and metastatic infections, primarily in the lungs.

Robert C. Ryan, MD, Chuck J. Cucchiara, MD, Frank Rabito, MD, and Jose L. Veras-Pola, MD. Family Medicine Residency Program, Service of Infectious Disease, East Jefferson General Hospital, Metairie, LA.