A young girl with a sore throat.

Abstract

BACKGROUND Tonsillitis is a common disease, and most cases proceed without complications. Common causes are viral and streptococcal infections. Sometimes the course of the disease is complicated, and interdisciplinary assessment is required. CASE PRESENTATION A previously healthy teenage girl was admitted after two weeks with throat pain. In the days before admission the pain worsened, a swelling developed on her neck and she developed lockjaw. CT-scans showed peritonsillar abscess, jugular vein thrombosis and septic embolism in the lungs. Streptococcus anginosus was found in blood cultures. The patient was treated with intravenous clindamycin and penicillin, in addition to anticoagulation therapy. Tonsillectomy was performed on day four after admission. INTERPRETATION Lemierre syndrome is an uncommon syndrome which often affects young, healthy people. The first symptoms are pharyngitis, tonsillitis and fever. The bacteria, most frequently Fusobacterium necrophorum, spread to the jugular vein and lead to thrombophlebitis and blood clot formation. Furthermore, septic embolies can occur and spread to the lungs, liver, kidneys, heart, joints and brain. Treatment of the syndrome requires interdisciplinary assessment. In our case paediatricians, ENT surgeons and specialists in infectious diseases were involved. Intravenous antibiotics with beta-lactamase resistance are recommended, in combination with beta-lactam antibiotics. Anticoagulation therapy should be considered.