Lemierre's syndrome: an unusual cause of calf abscess.

Blood cultures and intraoperative tissue cultures grew gram-negative rods on Day 2 of admission, from which Fusobacterium necrophorum was isolated. Referral was made to the Infectious Disease specialist and antibiotic therapy was changed to intravenous penicillin and metronidazole when the culture results were available. A diagnosis of Lemierre’s syndrome was made and further work up was done to exclude associated pathology. These included a CT pulmonary angiogram and ultrasonography of the jugular veins to exclude associated pulmonary embolism and jugular vein thrombosis. CT pulmonary angiogram revealed left lower lobe consolidation but no pulmonary emboli. There was no ultrasonic evidence of jugular vein thrombosis. The patient responded positively to the surgical drainage of the calf abscess and intravenous antibiotics regime. The infl ammatory markers showed a corresponding downward trend. By Day 8 of admission, C-reactive protein had come down to 45 mg/L and white cell count was 6.5 x 109/L. The patient underwent a repeat wound debridement and Dear Editor, Lemierre’s syndrome is a rare disease caused by Fusobacterium necrophorum, a Gram-negative anaerobic bacillus that is associated with oropharyngeal infections. We describe a case of a 16-year-old male presenting with acute calf abscess caused by an unusual organism, Fusobacterium necrophorum. Based on our review, this is the fi rst published report where a calf abscess was the presenting feature of Lemierre’s syndrome.