A Case of Severe Pneumonia and Jaundice in a Young Man: An Atypical Presentation of an Uncommon Disease: Category: Clinical lesson

Abstract

We present a patient with an atypical presentation of Fusobacterium infection, the genus responsible for Lemierre’s syndrome. This syndrome, which often affects healthy, young people and can be fatal if not recognized and treated early, is defined as a history of recent oropharyngeal infection with clinical or radiological evidence of internal jugular vein thrombosis and isolation of anaerobic pathogens, mainly Fusobacterium necrophorum. The history, presentation, investigations and management of the patient are described and then contrasted with the existing literature surrounding Lemierre’s syndrome, once termed the ‘forgotten disease’. Case report A previously fit and well 26-year-old male presented to hospital with a 3-day history of severe sore throat, general malaise, non-bloody diarrhoea, vomiting, fever and headache. He had no significant past medical history, did not take any medications and had no known allergies. He was an electric engineer who worked with air conditioning units and was an occasional drinker, a non-smoker and lived with his fiance´, their two children and a dog. He had no history of foreign travel and no risk factors for blood-borne viruses. On initial examination, the patient was clammy and febrile with jaundiced sclera. He had pharyngeal erythema and decreased air entry in the right lung base. Heart sounds were normal. He was tachycardic at 150 beats min 21 but