Lemierre syndrome making an encore in the post-antibiotic era: A case report

Lemierre syndrome is a rare complication of an acute oropharyngeal infection. The disease is characterized by antecedent protracted pharyngitis, septic thrombophlebitis of the internal jugular vein, and secondary septic embolization to distant sites. We present a case of a previously healthy 17-year-old female with a sore throat and unilateral neck pain of 3-day duration. She tested positive for cytomegalovirus, Epstein-Barr virus, and Mycoplasma pneumoniae. Lemierre syndrome was diagnosed by contrast-enhanced computed tomography (CT) of the neck and chest. She experienced full recovery after four weeks of combined beta-lactam antibiotic and metronidazole and no anticoagulant therapy. Lemierre syndrome remains a diagnostic challenge due to its rarity. In the post-antibiotic era, atypical causative pathogens are commonly seen. Contrast-enhanced CT of the neck serves as the gold standard for the diagnosis of Lemierre syndrome. This case highlights the importance of having a high index of suspicion for an early accurate diagnosis, appropriate treatment, and optimal outcome.