Disclosures: Danielle Mitchel, MD: No financial relationships or conflicts of interest

Case Diagnosis: An 18-year-old man with Lemierre’s Syndrome.

Case Description: An 18-year-old man with no significant past medical history presented to the emergency department with a sore throat and right-sided neck pain that evolved into fevers, myalgias, left knee pain, and dyspnea. Extensive work-up revealed blood and synovial cultures positive for Fusobacterium necrophorum. Cultures of his 5 cm right neck abscess grew Staphylococcus hominis. A CT chest showed multiple cavitating nodules suggestive of septic emboli and a loculated right pleural effusion. Cultures of the right pleural fluid also grew Staphylococcus hominis. Upper extremity venous ultrasound revealed a right internal jugular deep vein thrombosis that was treated with long-term rivaroxaban. Given his presentation, he was diagnosed with Lemierre’s Syndrome.

Setting: Acute inpatient rehabilitation hospital.Assessment/

Results: He was transferred to acute inpatient rehabilitation on intravenous antibiotics. During his rehab stay, he developed exquisite right hip pain and fevers. MRI of the right hip showed septic hip arthritis and femoral head osteomyelitis requiring transfer back to acute care for urgent incision and drainage. After the procedure he returned to rehab. With multimodal pain control and therapy, he was able to be discharged home at independent and modified-independent levels for all ADLs and IADLs.

Discussion: Lemierre’s Syndrome is a rare, severe illness that occurs in young, healthy adults. The syndrome is due to oropharyngeal infection caused by Fusobacterium necrophorum leading to thrombophlebitis of the internal jugular vein and bacteremia with septic emboli to distant sites including the lungs, joints, and bones. Antibiotics are essential for treatment.

Conclusion: As a disease that only occurs in 3.6 people per million, Lemierre’s syndrome is not common in the acute rehabilitation setting. It is important to be vigilant with patients who have this diagnosis. New sites of pain, pain resistant to multimodal treatment, and reemergence of fever should trigger further workup.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/lemierres-syndrome-with-new-onset-septic-arthritis-in-the-acute-inpatient-rehab-setting-a-case-report/