Lemierre's syndrome and rapidly deteriorating respiratory failure in the emergency department

Rapidly progressive acute respiratory distress along with life-threatening gram-negative anaerobic sepsis in a young, immunocompetent individual should always raise concern for Lemierre's syndrome. Although still rare, the incidence of Lemierre's syndrome has been increasing over the past 20 years. Lemierre's syndrome is characterized by postanginal septicemia and secondary internal jugular vein suppurative thrombophlebitis. In the emergency department (ED), patients often present with evidence of sepsis and secondary septic emboli to different organs, primarily the lungs.We report a case of a 24-year-old patient who presented to the ED with acute respiratory distress with an atypical and rapidly deteriorating course. She was later diagnosed with Lemierre's syndrome and recovered well after antibiotic treatment, respiratory support, and a lengthy intensive care unit stay. This case report represents an atypical presentation of acute respiratory distress and pharyngitis but is classic for Lemierre's syndrome.