A 15-Year-Old with Sepsis and Cavitary Lung Lesions

We report the case of a critically ill patient with Lemierre syndrome. Lemierre syndrome is characterized by septic thrombophlebitis of the internal jugular vein and metastatic abscesses in different organs, most frequently in the lungs. The disease usually occurs in young, previously healthy individuals. Most cases are caused by Fusobacterium necrophorum, an anaerobic gram-negative rod. Oropharyngeal infection occurring 2–3 weeks prior to septicemia is a harbinger of the syndrome. Frequently oropharyngeal symptoms and local signs are absent at the time of presentation. Computed tomography (CT) scan of the neck with contrast is the most helpful diagnostic study to identify internal jugular vein thrombosis. Treatment involves a prolonged course of intravenous antibiotics with anaerobic coverage. It is important for an intensivist to keep this syndrome in mind, especially when dealing with a young, otherwise healthy patient with sepsis. Mortality is high if the disease is not diagnosed and treated promptly. The syndrome is rare in the antibiotic era, therefore a high index of suspicion is essential.