Not always as simple as a UTI: An atypical case of Lemierre's syndrome, the forgotten disease

Abstract

A 65-year-old man, who was previously fit and well with no known medical comorbidities, was admitted with symptoms of dysuria, urinary frequency, pyrexia, chills and lethargy. His vitals showed that he was hypotensive, tachycardic and pyrexial. Urine dip was heavily positive for leukocytes and nitrites and had markedly elevated inflammatory markers and mild acute kidney injury. He was commenced on piperacillin/tazobactam. He went on to develop severe left-sided neck swelling and erythema. Ultrasound of the neck with subsequent computed tomography revealed extensive internal jugular vein thrombosis with abscess collection around the vein. Microbiology grew Gram-negative bacilli, later identified as Fusobacterium necrophorum. A diagnosis of Lemierre's syndrome was made. The patient was continued on intravenous piperacillin/tazobactam and metronidazole as per sensitivities and later switched to oral metronidazole. He was initiated on warfarin anticoagulation. He made a remarkable recovery and was discharged with outpatient ear, nose and throat and haematology follow-up.