Abstract Introduction Lemierre’s syndrome is a rare, life-threatening condition characterised by septic thrombophlebitis of the internal jugular vein (IJV), with an incidence of 14.4 cases per million per year among individuals aged 15-24. The pathophysiology typically involves an oropharyngeal infection, most commonly by Fusobacterium necrophorum, that extends to the IJV - leading to the formation of a septic thrombus. We present a case involving a previously unreported microbe. Case Presentation A previously healthy 18-year-old male presented with a 5-day history of fever, headache, sore throat, and left-sided neck pain. Examination was notable for tachycardia, tachypnea, a tender left anterior neck, and cervical lymphadenopathy. Laboratory studies revealed leukocytosis with bandemia, lactic acidosis, significantly elevated C-reactive protein and procalcitonin levels. CT of the neck with soft tissue showed asymmetric soft tissue stranding in the left neck and a single non-occlusive thrombus in the left IJV, concerning for Lemierre’s syndrome. Empiric intravenous therapy with vancomycin, ceftriaxone, and metronidazole was initiated. On day 2, his course was complicated by acute hypoxic respiratory failure, prompting a CTA of the chest, which ruled out pulmonary embolism but revealed bilateral nodular consolidations with ground-glass opacities and reactive hilar adenopathy, raising concern for septic emboli. Vascular surgery performed an urgent left IJV resection for source control, with intraoperative cultures from the thrombus growing Cutibacterium acnes. Heparin drip was initiated post-resection, later transitioning to rivaroxaban for a total duration of four weeks. He was discharged on a one-week course of intravenous ceftriaxone and oral metronidazole, followed by de-escalation to amoxicillin-clavulanate. A two-month follow-up neck ultrasound showed near-complete resolution of the soft tissue inflammation, supporting the discontinuation of antibiotic therapy. Conclusion Lemierre’s syndrome remains a diagnostic challenge due to its rarity in clinical practice. This case highlights a novel microbial association with Cutibacterium acnes, which, to our knowledge, has not been previously reported. While antibiotic therapy remains the cornerstone of treatment, evidence supporting anticoagulation in this population is limited. Our decision to initiate anticoagulation was based on the extent of septic thromboembolism with pulmonary involvement. This case contributes to the growing evidence on the role of anticoagulation in Lemierre’s syndrome among specific patient populations. This abstract is funded by: None
Sunny et al. (Fri,) studied this question.
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