The Forgotten Disease: An Atypical Case Of Lemierre’s Syndrome Presenting As A Shoulder Abscess
Lemierre's Syndrome is an acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein and distant septic emboli. It is a rare and potentially fatal disease.
A 29-year-old female presented to an urgent care with sore throat, shortness of breath and left shoulder pain. She was prescribed antibiotics for pneumonia. Four days later she presented to emergency department with worsening symptoms. She was tachycardic, tachypneic and hypoxic. Initial laboratory findings included profound neutrophilic leukocytosis. Computed topography of neck and chest revealed multiple loculated abscesses on deep left shoulder and retro-clavicular soft tissue, right peritonsillar abscess, thrombosis of a branch of right external jugular vein and multiple bilateral septic emboli to lungs. She was started on Clindamycin and Ampicillin-Sulbactam. She developed septic shock and required intubation due to respiratory failure. She underwent drainage of left shoulder abscess and tissue culture grew Fusobacterium. After two weeks of complicated intensive care unit stay, patient was transferred to medicine floor after improvement of hemodynamic and respiratory status.
Lemierre's Syndrome usually involves internal jugular vein, but rarely involves external jugular vein or its branches. Furthermore, septic emboli to lungs are common but soft tissue abscess of shoulder is very rare. Shoulder abscess was the unusual complication in our patient and was also the reason the patient decided to seek medical care initially. Regardless of the presentation, it is potentially a fatal disease requiring prompt diagnosis and management. An un-resolving sore throat in appropriate clinic setting should prompt the physician to consider Lemierre's Syndrome.