Lemierre Syndrome: A Diagnosis behind the Veil

Abstract

Lemierre syndrome (LS) is a rare, serious infection that is often misdiagnosed, as it frequently mimics common upper respiratory infections. It is even rarer for LS to be preceded by a viral infection. We share a case of LS in a young man who presented to the Emergency Department with COVID-19 viral infection followed by a subsequent LS diagnosis. The patient’s condition initially worsened despite treatments for COVID-19 and was subsequently started on broad-spectrum antibiotics. He was then diagnosed with LS after blood cultures grew Fusobacterium necrophorum, and antibiotics were adjusted accordingly, resulting in improvement of symptoms. Even though LS is often recognized as a sequela of bacterial pharyngitis, preceding viral infections, including COVID-19, might be a risk factor that contributes to the development of LS.

A man with culture sterile cavitating lung lesions: molecular techniques can provide the key to diagnosis

“…Our case was particularly challenging as serial blood cultures as well as tissue and bronchoalveolar lavage (BAL) cultures were all negative. There have been multiple recent case reports of LS thought to be precipitated by COVID-19 infection [4–6]; it is possible that the COVID-19 infection may have provoked LS in this case.…”