A Subtle Presentation of Pharyngitis and Pneumonia: Lemierre Syndrome

Lemierre syndrome (LS) is a rare condition with an estimated incidence of 1-10/1,000,000 per year defined as a complication of an oral and nasopharyngeal infection with secondary septicemia leading to septic emboli and internal jugular vein thrombosis. This syndrome was first described by Andre' Lemierre in 1936, before the development of antibiotics. In the preantibiotic era, it was a common condition and it was often characterized by a fatal course within 7-15 days with a mortality rate that could reach up to 80% of cases. After the development of antibiotic therapies, the incidence of LS rapidly declined, and nowadays, it is also known as "the forgotten disease," but the mortality risk remains high (5%) especially in case of diagnostic delay and inappropriate therapies. We presented a case of a 23-year-old who was referred to our hospital for worsening dyspnea associated with high fever following a pharyngitis in order to raise awareness about this severe rare disease. Long-term outcomes are usually good if proper treatment is started with no delay. The mainstays of treatment for the pulmonary and vascular aspects are antibiotic treatment with or without anticoagulation and chest-tube drainage.