Intractable Pyopneumothorax due to Lemierre's Syndrome Treated With an Endobronchial Watanabe Spigot (EWS)

Lemierre's syndrome is a rare condition characterised by internal jugular vein thrombophlebitis and bacteremia caused by anaerobic organisms following an oropharyngeal infection. We report the case of a 29-year-old woman who presented with fever, sore throat, dyspnea, and chest pain. Chest computed tomography (CT) revealed lung suppuration, pneumothorax, and thrombosis of the left internal jugular vein, confirming the diagnosis of Lemierre's syndrome. During treatment, she developed pyothorax with bronchopleural fistulas and intractable pneumothorax. Although antibiotics and thoracic drainage controlled the infection, persistent air leakage and incomplete lung expansion remained. Placement of an endobronchial watanabe spigot (EWS) successfully resolved the air leak, allowing the patient to avoid surgery and be discharged. This case highlights the effectiveness of EWS in managing intractable pyopneumothorax secondary to Lemierre's syndrome.