SHM Converge Scientific Abstract ePoster Gallery-Fusobacterium Nucleatum Bacterial Pharyngitis Leading to Disseminated Intravascualr Coagulation, Septic Emboli, and Bacteremia: An Unusual Lemierre's Disease Presentation

Fusobacterium Nucleatum Bacterial Pharyngitis Leading to Disseminated Intravascualr Coagulation, Septic Emboli, and Bacteremia: An Unusual Lemierre's Disease Presentation

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This case describes a rare, severe presentation of Lemierre’s disease in a 20-year-old healthy college student with three weeks of worsening pharyngitis, cyclic fevers, dehydration, neck pain, rigors, and later hallucinations during fever spikes. She initially received azithromycin for presumed routine pharyngitis, but symptoms quickly returned after completion. On hospital admission, she was febrile, tachycardic, and had exudative pharyngitis, neck tenderness, elevated inflammatory markers, thrombocytopenia, and early negative cultures and imaging. The initial working diagnosis was sepsis/pharyngitis, later broadened as she developed hypoxia, cough, pneumonia, abdominal edema, and CT evidence of septic emboli.<br /><br />Further workup ultimately revealed blood and throat cultures growing Fusobacterium nucleatum, sensitive to beta-lactams. She was treated with IV Unasyn and then discharged on a prolonged course of oral amoxicillin for 42 days. Repeat chest CTs showed improving septic emboli with residual atelectasis, ground-glass opacities, and pleural effusion. She gradually recovered, though she had lingering pulmonary symptoms for some time after discharge and later returned to running.<br /><br />The report highlights classic and atypical features of Lemierre’s disease, including severe pharyngitis, cyclic fevers, joint pain, thrombocytopenia, and septic emboli to the lungs. It emphasizes that the illness often affects young, otherwise healthy adults and can be fatal without antibiotics. The case also underscores the importance of reconsidering the diagnosis when symptoms worsen after initial treatment and of timing blood cultures to coincide with fever spikes.

Asset Subtitle

Leah Hawksford

Meta Tag

Author List Katrina A. Pfaffenbach, Leah Hawksford, Pinky Jha

Category Clinical Vignettes

Concept Lemierre Syndrome

Concept Fusobacterium nucleatum

Concept Throat Pain

Concept Blood Culture

Concept Septic Emboli

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Leah Hawksford

Track Adult

Keywords

Lemierre’s disease

Fusobacterium nucleatum

septic emboli

pharyngitis

cyclic fevers

young adult

thrombocytopenia

pneumonia

blood cultures

amoxicillin

Lemierre Syndrome

Fusobacterium nucleatum

Throat Pain

Blood Culture

Septic Emboli