SHM Converge Scientific Abstract ePoster Gallery-Beyond the Neck: An Atypical Presentation of Lemierre's Syndrome Masked by Altered Mental Status

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Lemierre’s syndrome (LS) is a rare but potentially fatal condition that requires early recognition and treatment. This case highlights how LS can present atypically and be missed when symptoms are confounded by altered mental status.<br /><br />A 32-year-old man with alcohol use disorder and delirium tremens was admitted to the ICU for alcohol withdrawal and sepsis attributed to septic arthritis. Despite appropriate antibiotic therapy, his condition did not improve and his mental status continued to wax and wane. He later developed tender swellings on the left side of his neck and chest wall, prompting further evaluation.<br /><br />Imaging revealed cavernous sinus thrombosis extending into the left internal jugular vein on brain MRI, and CT of the chest showed extensive chest wall and mediastinal abscesses. Blood cultures grew gram-positive cocci. He was treated with incision and drainage of a left neck abscess, antibiotics, and anticoagulation.<br /><br />The discussion emphasizes that LS typically affects young adults and is most commonly caused by Fusobacterium necrophorum, though other organisms can be involved. Classic presentation includes sore throat, fever, and tonsillar or pharyngeal findings, with common complications such as septic emboli, especially to the lungs. Diagnosis relies on imaging and cultures, and treatment includes broad-spectrum antibiotics plus surgical drainage when needed.<br /><br />The key lesson from this case is that if sepsis does not improve despite appropriate antibiotics, uncommon causes should be considered. In patients unable to give a reliable history, such as those with altered mental status, a careful physical examination is essential to detect atypical signs and pursue the correct diagnosis.

Asset Subtitle

Sai A. Vanka

Meta Tag

Author List Abrar Hasan, Constangela Matos Noboa, Keerthi Cedeno, Sai A. Vanka

Category Clinical Vignettes

Concept Lemierre Syndrome

Concept Sepsis

Concept Atypical Presentation

Concept Antibiotic Therapy

Concept Physical Examination

Distinguished Non-Finalist

Presenter Organization Montefiore Medical Centre

Presenting Author Sai A. Vanka

Track Adult

Keywords

Lemierre syndrome

sepsis

altered mental status

cavernous sinus thrombosis

internal jugular vein thrombosis

neck abscess

mediastinal abscess

Fusobacterium necrophorum

antibiotic therapy

incision and drainage

Lemierre Syndrome

Sepsis

Atypical Presentation

Antibiotic Therapy

Physical Examination