Lemierre Syndrome Presenting With Septic Pulmonary Emboli: A Case Report and Diagnostic Challenges

Lemierre syndrome is a rare but potentially life-threatening complication of oropharyngeal infection characterized by septic thrombophlebitis of the internal jugular vein and metastatic septic embolization. Because initial manifestations often resemble uncomplicated pharyngitis, diagnosis may be delayed and lead to significant morbidity. We report the case of a 34-year-old, previously healthy man who presented with persistent fever, sore throat, dyspnea, and cervical tenderness despite outpatient antibiotic treatment. Laboratory evaluation demonstrated a marked inflammatory response, while non-contrast chest computed tomography revealed multiple bilateral peripheral pulmonary nodules, several exhibiting central cavitation and findings suggestive of septic pulmonary emboli. Duplex ultrasonography confirmed left internal jugular vein thrombosis. Blood cultures remained negative. Broad-spectrum antimicrobial therapy with anerobic coverage was initiated, followed by therapeutic anticoagulation after radiological confirmation of thrombosis, and the patient was subsequently transferred to a tertiary referral center for further management. This case highlights the importance of maintaining a high index of suspicion for Lemierre syndrome in patients with persistent systemic symptoms following pharyngitis, even in the absence of positive blood cultures. Early recognition and timely imaging evaluation, together with prompt initiation of appropriate therapy, remain essential to limit disease progression.