SHM Converge Scientific Abstract ePoster Gallery-The Rarest of the Rare: Lemierre's Syndrome With Soft Tissue Abscesses and Osteomyelitis

Pdf Summary

This case describes a 25-year-old woman with asthma who presented with one week of sore throat, cough, shortness of breath, nausea, vomiting, and diarrhea, and arrived in septic shock. She was hypotensive, tachycardic, tachypneic, and febrile, with marked inflammatory and metabolic abnormalities including leukocytosis, elevated lactate, and very high procalcitonin. Blood cultures grew <strong>Fusobacterium necrophorum</strong>, supporting a diagnosis of <strong>Lemierre syndrome</strong>.

Initial imaging showed a <strong>peritonsillar abscess</strong>, but notably <strong>no internal jugular vein thrombophlebitis</strong>, which is the classic finding in Lemierre syndrome. The patient also had a <strong>right shoulder abscess</strong> seen on MRI. Despite several weeks of antibiotic therapy, she later developed <strong>septic arthritis of the left hip</strong>, but eventually recovered over six weeks.

The discussion emphasizes that Lemierre syndrome is a rare but increasingly recognized infection, often called “the forgotten disease,” with an incidence of about <strong>1–2 cases per million per year</strong>. Classically, it follows an oropharyngeal infection caused by <em>F. necrophorum</em>, leading to septic thrombophlebitis of the internal jugular vein, bacteremia, and septic emboli, especially to the lungs. However, hematogenous spread can also affect other organs, including the heart, liver, central nervous system, soft tissues, and bone. <strong>Osteomyelitis and soft tissue infections are especially uncommon, occurring in only about 3% of cases.</strong>

This unusual case is notable for severe pharyngitis with peritonsillar abscess, bacteremia, cavitary lung lesions, soft tissue abscess, osteomyelitis of the acromion, and delayed septic arthritis—despite absent IJ thrombophlebitis. The report highlights the importance of early recognition and treatment, since more than half of patients require ICU care and delayed diagnosis can be fatal.

Asset Subtitle

Hojin Sun

Meta Tag

Author List Hojin Sun, Leigh K. Hunter

Category Clinical Vignettes

Concept Lemierre Syndrome

Concept Fusobacterium necrophorum

Concept Oropharyngeal Infection

Concept Bacteremia

Concept Septic Shock

Distinguished Non-Finalist

Presenter Organization Methodist Dallas Medical Center

Presenting Author Hojin Sun

Track Adult

Keywords

Lemierre syndrome

Fusobacterium necrophorum

peritonsillar abscess

septic shock

bacteremia

septic arthritis

osteomyelitis

soft tissue abscess

pharyngitis

internal jugular thrombophlebitis

Lemierre Syndrome

Fusobacterium necrophorum

Oropharyngeal Infection

Bacteremia

Septic Shock