A50-23 From Neck Pain to Septic Emboli: Rapidly Progressive Lemierre’s Syndrome Diagnosed by Bedside Ultrasound

Abstract Introduction Lemierre’s syndrome is a rare, life-threatening condition characterized by septic thrombophlebitis of the internal jugular vein following oropharyngeal infection. While nearly eradicated over the past century, increasing incidence has been identified in healthy young adults. Etiology is primarily due to Fusobacterium necrophorum infection of the oropharynx leading to internal jugular vein thrombosis and septic emboli. This disease often poses a diagnostic challenge due to its rarity and nonspecific presentation. We present a unique case of Lemierre’s Syndrome showing rapid development of pulmonary septic emboli on short interval CT imaging with diagnosis solidified on bedside ultrasonography, managed without the need for anticoagulation. Case Description A 19-year-old male, with no significant past medical history, presented to the emergency department with pharyngitis, myalgias, fatigue, pleuritic chest pain, and right neck tenderness. Vitals demonstrated tachycardia, hypotension, and fever. The patient was seen 2 days prior in the ER with clear lung fields on CT chest and was discharged with a URI but returned for progressive symptoms. Labs demonstrated leukocytosis, thrombocytopenia, acute kidney injury, elevated lactate, and positive Strep A screening. Repeat CT chest imaging was consistent with multifocal septic emboli with “feeding vessel sign”. The patient was admitted to the ICU for septic shock. Bedside point-of-care ultrasound, later confirmed with formal study, identified a thrombus in the right internal jugular vein consistent with the diagnosis of Lemierre’s syndrome. Blood cultures confirmed growth of Fusobacterium necrophorum with eventual de-escalation to ampicillin-sulbactam; anticoagulation was deferred. The patient was discharged 7 days later with outpatient IV antibiotics. He was later readmitted for a developed parapneumonic pleural effusion with sterile culture. The patient was safely discharged to complete an appropriate antibiotic course. Novelty and Importance This case demonstrates the importance of maintaining a broad differential when a young individual presents with pharyngitis and neck pain. Early diagnosis and treatment are necessary to prevent mortal complications, as seen in this patient, who rapidly developed septic emboli. While contrast-enhanced CT is the gold standard to identify septic thrombophlebitis, bedside ultrasound can serve as a valuable diagnostic tool to confirm thrombus formation especially in those with contraindications to contrast. The role of anticoagulation has been debated. In this case, anticoagulation was deferred and the patient made a complete recovery with extended antibiotic therapy. This abstract is funded by: None