Lemierre's Syndrome in a 16-Year-Old Man Associated with Resolution of Marked Widespread St Elevation and a Normal Troponin Level.

A 16-year-old man presented to the Accident and Emergence services with a 10-day history of shortness of breath, sore throat, vomiting, diarrhoea, poor oral intake, chest pain, jaundice, diplopia and reduced urine output. He was initially treated for sepsis, however, subsequent imaging and blood cultures confirmed the diagnosis of Lemierre's syndrome (LS). LS, also known as necrobacillosis or post-pharyngitis anaerobic septicaemia is comprised of a triad of metastatic septic emboli secondary to pharyngitis, bacteraemia, and internal jugular vein thrombophlebitis. LEARNING POINTS: The incidence of Lemierre's syndrome (LS) is rising possibly to antibiotic resistance and fewer tonsillectomies which should increase awareness of the signs and symptoms of LS. It is no longer the forgotten disease.Pharyngitis can have serious complications including glomerulonephritis, rheumatic fever, and tonsillar cysts. However, LS is one of the most fatal complications of pharyngitis and must certainly be considered in the differential diagnoses.Even if the sore throat resolves post oropharyngeal infection or the blood culture comes back negative, if the patient is feeling unwell, this should be treated as a red flag for further investigations. Prompt investigation and management of LS is the key to saving patient's life as the mortality rate in LS is high.