Lemierre syndrome: a needle in a haystack.

A young woman with no significant past medical history presented with worsening cough, swinging fevers, persistent chest pain and neck tenderness. On examination she was tachycardic, hypotensive, pyrexial and became increasingly confused. Inflammatory markers in her blood were raised, but the chest film showed clear lung fields and urinalysis was negative. The impression was sepsis query source and broad-spectrum intravenous antibiotics were commenced. The patient deteriorated into respiratory failure and was transferred to intensive care. Some days after admission, an anaerobic bacillus, known to cause Lemierre syndrome, was cultured from her blood sample. The patient was treated with organism-sensitive antibiotics and improved over the next few days. She was discharged after further radiological investigations returned normal.