A rare case of Achromobacter Xylosoxidans infection presenting as Lemierre's syndrome complicated with bilateral lung empyema in a young boy

Abstract

Background: In the recent decades, Lemierre\'s syndrome (LS) has been increasingly diagnosed with a wide range of causative organisms, especially with increased awareness of such an entity. Case Presentation: We report an unusual case of LS in a previously healthy 15-year-old boy who presented initially with high grade fever, nonspecific gastrointestinal symptoms, and unilateral purulent otorrhea. Patient subsequently deteriorated requiring intensive care and exhibited altered mental status prompting an urgent contrast enhanced computed tomography brain which clinched the diagnosis. Patient underwent mastoidectomy followed by IV antibiotics that were streamlined according to his pus culture. He also developed bilateral lung empyema requiring bilateral chest tube drainage. Anticoagulation was commenced for the thrombosis and patient was discharged home well. Conclusion: This was an intriguing case in view of the unusual organism causing LS, initial diagnostic dilemma, and challenges in management.