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Case Reports in Medicine
Volume 2012 (2012), Article ID 624065, 4 pages
http://dx.doi.org/10.1155/2012/624065
Case Report

Lemierre’s Syndrome: Rare, but Life Threatening—A Case Report with Streptococcus intermedius

1Department of Internal Medicine, Oregon Health Science University, P.O. Box BTE 119, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
2Infectious Diseases Division, Department of Medicine, Buffalo General Hospital, University at Buffalo, 100 High Street, B-8, Buffalo, NY 14203, USA

Received 15 August 2012; Accepted 1 October 2012

Academic Editor: Anthony W. Chow

Copyright © 2012 Shalini Gupta and Shehzad S. Merchant. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Lemierre’s syndrome (LS) is a rare, but a life-threatening complication of an oropharyngeal infection. Combinations of fever, pharyngitis, dysphagia, odynophagia, or oropharyngeal swelling are common presenting symptoms. Infection of the lateral pharyngeal space may result in thrombosis of the internal jugular vein, subsequent metastatic complications (e.g., lung abscesses, septic arthritis), and significant morbidity and mortality. LS is usually caused by the gram-negative anaerobic bacillus Fusobacterium necrophorum, hence also known as necrobacillosis. We present a case of LS caused by Streptococcus intermedius, likely secondary to gingival scraping, in which the presenting complaint was neck pain. The oropharyngeal examination was normal and an initial CT of the neck was done without contrast, which likely resulted in a diagnostic delay. This syndrome can be easily missed in early phases. However, given the potential severity of LS, early recognition and expedient appropriate antimicrobial treatment are critical. S. intermedius is an unusual cause of LS, with only 2 previous cases being reported in the literature. Therefore, an awareness of the myriad presentations of this syndrome, which in turn will lead to appropriate and timely diagnostic studies, will result in improved outcome for LS.