B103-10 Lemierre’s Syndrome Presenting as Septic Shock in a Healthy Young Woman: A Forgotten But Fatal Disease

Abstract Introduction Lemierre’s syndrome is a rare but potentially fatal complication of oropharyngeal infection, characterized by septic thrombophlebitis of the internal jugular vein, most often caused by Fusobacterium necrophorum. Although its incidence has declined in the antibiotic era, delayed recognition can result in septic shock and multiorgan failure. With fewer than one case per million annually, it remains a diagnostic challenge. We present a case of Lemierre’s syndrome manifesting as septic shock in a previously healthy young woman. Case Presentation An 18-year-old woman presented with a two-week history of worsening sore throat, left ear pain, fatigue, nausea, vomiting, and diarrhea following recent travel. On arrival, she appeared acutely ill with systolic blood pressure in the 80s mmHg. Laboratory results showed lactate 4.7 mmol/L, WBC 3.9 × 109/L, platelets 23 × 109/L, CRP 23.5 mg/dL, and procalcitonin 37.3 ng/mL. Respiratory PCR was positive for rhinovirus/enterovirus. Physical examination revealed a bulging, erythematous left tympanic membrane and tender swelling over the left neck. She received intravenous fluids, piperacillin-tazobactam, vancomycin, norepinephrine, and stress-dose steroids for septic shock. Blood cultures grew Fusobacterium necrophorum, prompting CT angiography of the neck, which demonstrated left tonsillitis/pharyngitis with a small peritonsillar focus and occlusion of the left internal jugular vein extending into external jugular branches—consistent with Lemierre’s syndrome. Antibiotics were narrowed to ampicillin-sulbactam, and dexamethasone was initiated by otolaryngology. Anticoagulation was deferred after hematology consultation due to thrombocytopenia and limited supporting evidence. The patient improved clinically, with normalization of platelet count and resolution of shock, and was transitioned to oral metronidazole on discharge. Discussion Lemierre’s syndrome remains an underrecognized cause of severe sepsis in young adults. It should be suspected in patients with persistent pharyngitis and neck pain, particularly when Fusobacterium bacteremia is present. Septic emboli to the lungs are common and relevant to pulmonary and critical care physicians. The role of anticoagulation is controversial and should be individualized. Early recognition, anaerobic coverage, and multidisciplinary management are essential to reduce morbidity and mortality. Learning Objectives 1. Recognize Lemierre’s syndrome as a cause of sepsis in young, healthy adults. 2. Emphasize early neck imaging and broad anaerobic coverage. 3. Discuss the role and controversies of anticoagulation in management. Impact Statement This case reinforces the importance of considering Lemierre’s syndrome in young patients with sepsis and neck pain, emphasizing early imaging and anaerobic coverage to improve outcomes. This abstract is funded by: None