An atypical presentation of Lemierre’s syndrome with eye and facial pain: A case report with Streptococcus intermedius

Introduction: Lemierre’s syndrome is rare but morbid complication that follows an acute oropharyngeal infection. seeding of an oropharyngeal infection into the lateral pharyngeal space can result in thrombosis of the internal jugular vein with subsequent septic metastasis. the most common presenting symptoms are fever, pharyngitis, odynophagia, oropharyngeal swelling and neck pain. the most common etiologic agent is Fusobacterium necrophorum. We are reporting a rare case in which the causative agent was streptococcus intermedius and the presenting symptoms were Jordana Cheta Affiliations: Critical Care and Nephrology Fellow, Eastern Virginia Medical School, 855 W. Brambleton Avenue, Norfolk, VA 23510 United States. Corresponding Author: Jordana Cheta MD, Critical Care and Nephrology Fellow, Eastern Virginia Medical School 855 W. Brambleton Avenue, Norfolk, VA 23510 United States; E-mail: [email protected] Received: 26 June 2016 Accepted: 16 September 2016 Published: December 2016 atypical. to the best of our knowledge this is the 4th case of streptococcus intermedius, resulting from a gingival procedure, with a normal oropharyngeal exam at time of presentation. case report: We describe a 78-year-old caucasian female, who presented with eye and facial pain, which resulted to be Lemierre’s syndrome. blood cultures grew streptococcus intermedius. Patient’s hospital course was complicated by parapharyngeal and masticator abscesses. Prompt treatment was initiated and the patient made a full recovery. conclusion: In the above case we had a patient in whom the presenting symptom was mistaken for facial cellulitis resulting in a delay of treatment and progression of symptoms. the presentation was not the typical symptoms of Lemierre’s syndrome, such as neck pain, pharyngitis, odynophagia, and fever. Likewise, the blood culture did not grow the usual causative bacteria. Due to the implementation of early treatment, which results in improved outcomes and decreased rates of complications, dependent upon early recognition of the disease, we are reporting this previously undescribed manifestation in hopes to increase awareness across multiple specialties of medicine.