And the diagnosis is…Lemierre’s syndrome! Great job F, ED Doc, Rich S, Erin, ColorMaven, and LG on what I thought was a difficult diagnosis!
Lemierre’s syndrome is a medical emergency that is caused by the Fusobacterium necrophorum bacteria. It affects mainly young, healthy adults. Lemierre’s syndrome is characterized by some classic findings: First, an oropharyngeal infection has to occur. This is usually diagnosed as tonsillitis or pharyngitis. This infection is due to the Fusobacterium necrophorum bacteria. This infection leads to a thrombosis (blood clot formation) in the internal jugular vein, which can lead to a septic emboli. This septic emboli can migrate to other parts of the body (such as the lungs) and cause serious, deadly complications. In this patient, the emboli was seen in the ultrasound of his internal jugular vein and an abscess in the orophraynx area was visible in the contrast CT.
Diagnosis is confirmed by growing out Fusobacterium necrophorum in blood culture, and treatment usually consists of antibiotic therapy and occasionally anticoagulants (although this use of anticoagulants is controversial). Most patients make a complete recovery.
Interestingly, the Fusobacterium necrophorum is a normal flora of the pharynx and gastrointestinal tract, but the platelet clumping subsequently allows this bacterium to propagate and therefore cause infection. Additionally, Lemierre’s disease was once thought to be a very rare complication of oropharyngeal infections, but new research shows that this disease is on the rise. However, with early diagnosis and proper treatment a full recovery is usually made. Thanks for playing along-have a great week!