Lemierres syndrome: cavitary lung disease caused by uncommon bacteria

Description 

A 32-year-old Asian man with a history of gastritis presented to the emergency room with abdominal pain, fever, cough and dyspnoea, one episode of haemoptysis. He also reported a sore throat 3 days ago. The patient was a sushi chef and an active smoker. Early lab work was remarkable for leucocytosis of 21 x10⁹/L, lactic acidosis of 3 mmol/L, bandaemia of 19% with a procalcitonin of >100 and platelets of 74 x10⁹/L . CT of the lungs was performed without contrast and was significant for multiple cavity lesions throughout the lungs (figures 1 and 2). The patient was intubated due to respiratory failure. He was empirically started on vancomycin, cefepime and azithromycin. A right internal jugular central line was attempted for triple lumen catheter placement but the vessel was not compressible. A CT scan of the neck revealed a right internal jugular vein 9 mm thrombosis (figure 3). Blood culture grew Fusobacterium necrophorum....

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