A Life-Threatening Pharyngeal Infection: Lemierre's Syndrome

A previously healthy 28-year-old woman who developed pharyngeal, pulmonary, and ocular manifestations due to Lemierre's syndrome is reported. High-grade fever, severe sore throat, neck pain, and diarrhea were the initial symptoms. Worsening of these symptoms following oral azithromycin therapy prompted the patient to present to our hospital's emergency department. Physical examination, chest X-ray, blood tests, and contrast-enhanced CT scans of the neck and chest revealed enlargement of the left palatine tonsil, thrombosis of the left internal jugular vein, multiple enlarged left cervical lymph nodes, and bilateral pulmonary consolidations, confirming the diagnosis. Admission to the intensive care unit (ICU) was required due to multiorgan failure. A combination of antibiotic therapy, anticoagulation, and surgical drainage of a left palatine tonsillar abscess was essential for a favorable outcome. After a left-sided pleural empyema was identified, a chest drainage tube was inserted for treatment. Conservative management was chosen for the ocular involvement. This case highlights the importance of maintaining a high index of clinical suspicion in primary care and emergency settings, as well as the early initiation of an appropriate antibiotic regimen, which can improve the prognosis and reduce morbidity and mortality. Its relevance is increasing, as recent guidelines for oropharyngeal infections may not adequately address this condition because of its low incidence.