Lemierre's syndrome in 15-year-old female.

INTRODUCTION A 15-year-old female initially presented to her primary care physician with sore throat, fever, difficulty swallowing, and neck swelling. A rapid strep test was performed and was positive. A CT of the neck was ordered and demonstrated moderate enlargement of the tonsils bilaterally, but no evidence of abscess (Image 1). The patient was admitted to the hospital and started on clindamycin 900 mg q8h IV, with improvement. She was switched to oral clindamycin 600 mg q8h, discharged on hospital day three, and instructed to complete an 18day course of antibiotics as an outpatient. Blood cultures obtained during the initial hospitalization were negative. Three days following discharge, the patient returned to her primary care physician with continued sporadic fevers and increasing left neck pain. Physical exam demonstrated an asymmetrically swollen left neck. A neck ultrasound was also ordered and demonstrated left internal jugular thrombophlebitis (Image 2). The patient was readmitted to the hospital. An MRI/MRA of the neck and face was ordered to further characterize the ultrasound findings and demonstrated thrombosis within the middle 3rd of the left internal jugular vein. There was severe soft tissue inflammation from the level of the left pterygoid musculature down to the level of C5/6. There was diffuse left sided cervical lymphadenopathy. The remainder of the vasculature throughout the neck was patent (Image 3). Image 1. CT of the neck demonstrating bilateral tonsilar enlargement, but no abscess.