Bilateral Empyema in Lemierre's Syndrome Due to Streptococcus pyogenes: An Atypical Presentation in an Immunocompromised Patient

Lemierre's syndrome (LS) is a rare yet severe condition that usually develops as a complication of oropharyngeal infection. Infection extends into the parapharyngeal space with subsequent septic thrombophlebitis of the internal jugular vein (IJV), which can result in septicaemia and metastatic lesions. Diagnosed cases of LS have significantly decreased with the introduction of antibiotics; however, several studies report ongoing incidence in recent years. The syndrome usually affects young, healthy individuals, and there is still an association with significant morbidity and mortality. In this report, we discuss an interesting case of a 56-year-old immunocompromised woman who presented with a parapharyngeal abscess and subsequently developed IJV thrombosis and bilateral multiloculated empyema requiring thoracoscopic debridement. The identified causative organism was Streptococcus pyogenes. There are few documented cases of LS in immunocompromised individuals or with Streptococcus organisms, as identified in this case. This presentation highlights the requirement of prompt imaging, intervention, and escalation of treatment for successful outcomes.