Abstract Introduction Lemierre syndrome is a rare, life-threatening complication of an oropharyngeal infection resulting in thrombophlebitis of the internal jugular vein (IJV). The most common etiology is fusobacterium necrophorum. Complications include lung abscess, necrotizing pneumonia, bacteremia, septic emboli and even death in young otherwise healthy patients. We present a rare case of incomplete Lemierre’s associated with cavitary necrotizing pneumonia, without the classic IJV involvement, that was admitted to our ICU. Case A 19 year-old female with a history of heavy vaping presented to the ED with syncope, shortness of breath, and chest pain. One month prior to the admission, she was diagnosed with strep throat and treated with two courses of oral antibiotics and prednisone. She failed to improve, ultimately getting admitted for septic shock and respiratory failure requiring intubation. She was treated with broad spectrum antibiotics and CT neck did not show any IJV thrombosis however CT chest showed diffuse bilateral infiltrates with cavitary pneumonia. BAL showed 90% neutrophils but was negative for MRSA nares, legionella, Strep pneumoniae, Aspergillus galactomannan, and PJP. Anaerobic blood cultures ultimately revealed fusobacterium necrophorum. Antibiotics were narrowed to unasyn and she was successfully extubated 8 days later. She was followed up outpatient where repeat CT showed resolution of cavitary nodules. Discussion Rare cases of Lemierre’s syndrome can present without IJV thrombosis. There are only a handful of case reports demonstrating atypical or incomplete Lemierre’s syndrome. Despite lack of IJV involvement, F. necrophorum infections may still result in severe, life-threatening complications with significant risk for morbidity and mortality. This case highlights the importance of early diagnosis and treatment of Lemierre’s syndrome to reduce the risk of distant complications like septic emboli, cavitary pneumonia and multiorgan failure. This case also emphasizes the importance of further investigating vaping related pharyngitis especially in younger adults (with increasing popularity of vaping in the age group of 13-19) who are prone to oropharyngeal irritation which can be further complicated by a superimposed infection, such as F. necrophorum. Early identification of atypical or incomplete Lemierre’s presentations are critical to preventing severe complications, highlighting the need for vigilance in patients with persistent oropharyngeal infections, especially amongst those who vape. This abstract is funded by: None
Panwar et al. (Fri,) studied this question.