• Vol. 34 No. 7, 450–453
  • 15 August 2005

A Case of Lemierre’s Syndrome Presenting with Multiple Pulmonary Abscesses Associated with a Tension Hydropneumothorax Resulting in a Mediastinal Shift

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ABSTRACT

Introduction: We report a case of Lemierre’s syndrome. Clinical Picture: A previously healthy 36-year-old woman presented with a 2- to 3-month history of fever, cough, dyspnoea and sore throat, which had worsened in the week prior to presentation. Computed tomography of the thorax showed multiple bilateral cavitating lesions and a right-sided hydropneumothorax with mediastinal shift. Blood cultures grew Fusobacterium and Bacteroides species. Treatment: Broad-spectrum antibiotics were commenced, a chest drain was inserted, and the patient was transferred to the intensive care unit due to worsening respiratory failure. Outcome: Despite intensive supportive care with broad-spectrum antibiotics, aggressive fluid resuscitation and high-dose inotropic support, the patient developed acute renal failure, disseminated intravascular coagulation and intractable shock, and succumbed 8 days later. Conclusions: Although this condition is uncommon, it should be considered in the differential diagnosis of patients with pulmonary cavitating lesions, especially in the context of fever and rigors preceded by a sore throat.


Lemierre’s syndrome (LS) is a condition which follows an oropharyngeal infection, often in an otherwise healthy young adult. This usually progresses to septic thrombophlebitis of the internal jugular vein (IJV), leading to metastatic abscesses mainly of the lungs, but organs such as the liver, bones, joints and kidneys can also be affected. In 1936, Lemierre first described one of these cases.1 The syndrome is thought to be uncommon now due to the widespread use of antibiotics in the primary setting, but if it does occur, its rarity may cause diagnostic difficulty. Moreover, if not detected and treated early, the condition can become fatal and mortality rates as high as 10% have been reported.2 We report here a case of advanced Lemierre’s syndrome in a young woman.

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