Lemierre's syndrome

Extended

Step 1: View clinicals

A 19 year old man presents with swelling and discomfort of the right side of his neck for 1 day, in a background of fever, a sore throat and difficulty in swallowing for 6 days. His symptoms have progressively worsened over time, even though he was started on oral Erythromycin 3 days ago. His medical and family histories are unremarkable. A full blood count is significant for a leukocyte count of 12,600/mm3 (93% Neutrophils).


Step 2: Order all relevant investigations

Throat Swab & Cultures

A gram stain reveals pleomorphic, gram-negative bacilli. The culture results will be available in 3 days.

CT Neck (Contrast)

There is a tubular hypodensity suggestive of right internal jugular vein (IJV) thrombosis; parapharyngeal soft tissue edema is present. A small lesion is also visualized in the upper lobe of the right lung.

X-Ray Chest

There are multiple, peripheral, ill defined nodules in both lung fields. Bilateral blunting of the costophrenic angles is noted.

Blood Cultures

Culture results will be available in 3 days.


Step 3: Select appropriate management

Thoracentesis
Anticoagulation
Gentamicin
Metronidazole


Score: ★★☆