A Rare case of Staphylococcus aureus Associated Lemierre's Disease Complicated by Pneumothorax

Lemierre's syndrome is a rare but life-threatening condition characterized by septic thrombophlebitis, most often due to Fusobacterium necrophorum. Although uncommon, Staphylococcus aureus can also cause atypical and severe presentations.

This case describes an unusual presentation of Lemierre's syndrome in an 18-year-old male, associated with Staphylococcus aureus and complications including left-sided secondary spontaneous pneumothorax, septic pulmonary emboli, and pleural effusion. The patient initially presented with fever, headache, periorbital swelling with double vision, neck pain, and acute onset left-sided chest pain with shortness of breath. Initial evaluations revealed thrombosis in the superior ophthalmic veins, cavernous sinuses, and bilateral internal jugular veins, along with left-sided pneumothorax and diffuse cavitating nodules in both lung fields. Blood cultures confirmed Staphylococcus aureus resistant to macrolides. Treatment includes high-flow oxygen, intravenous vancomycin followed by oxacillin, and anticoagulation therapy. At 3-month follow-up, the patient had fully recovered with resolution of pneumothorax and inflammatory markers.

This case highlights the importance of recognizing atypical presentations of Lemierre's syndrome and the need for prompt multidisciplinary intervention to prevent fatal outcomes.