Lemierre's syndrome caused by viridans streptococci: a case report

A 53-year-old man had fever, chills, and a progressively enlarged mass over the left mandibular angle for one month. A chest radiograph showed two small nodules in the upper right lung field. A contrast-medium-enhanced head-and-neck computed tomograph revealed severe necrosis within the left lateral pharyngeal space and total obliteration of the left internal jugular vein. Viridans streptococci were identified in the blood culture and the debrided tissue culture 2 days post-admission. The presentations were characteristic of Lemierre's syndrome and were evident in this case, however, the causative agent was viridans streptococci and the host was much older than the others previously reported. The normal flora of the oropharynx could become a fatal bacterium when the intact mucosal barrier of the mouth is impaired, regardless of the patient's age.