Abstract
Lemierre's syndrome is characterised by a potentially fatal septic thrombophlebitis and metastatic abscesses caused by Fusobacterium necrophorum (F. necrophorum). It probably occurs more commonly than realised, with 10% of cases of pharyngitis in young adults being due to F. necrophorum and an estimated 1 in 400 of these are likely to develop Lemierre's syndrome. Diagnosis by clinical means alone is difficult and requires a high degree of suspicion, pending laboratory/ radiological confirmation. We describe a case of a 26-year-old male who developed a coryzal illness with sore throat, misdiagnosed as H1N1 influenza in the recent surge, who failed to improve with conservative and antiviral treatment. He was subsequently hospitalised and ultimately required admission to the intensive care unit for the management of septic shock and respiratory failure. The diagnosis of Lemierre's syndrome was made after isolation of F. necrophorum in blood cultures and computerised tomography demonstration of diagnostic features, particularly a left internal jugular vein thrombosis. The mainstay of antibiotic management, as supported by the literature, is a beta-lactamase resistant penicillin or clindamycin together with metronidazole. The use of anticoagulation is controversial. This case highlights the increasing incidence of Lemierre's syndrome, partly due to the current trend to rationalise antibiotic use, and draws readers' attention to the current guidelines for management of pharyngitis from the USA and the National Institute for Health and Clinical Excellence, which recommends antibiotics for patients when three or more of the Centor criteria are met.