Don't Lament Lemierre!

No article here, but I wanted to reiterate an entity that is gaining more recognition: Lemierre syndrome.
WHEN  do I consider this lethal entity? Awareness of this dangerous disease occurs anytime someone starts with pharyngitis and returns 3-6 days later with markedly worse fever and neck pain. Once again, beware of the bounceback!!!!! 

WHAT is Lemierre syndrome? Lemierre is a syndrome of bacterial infection that starts in the throat, then progresses. The #1 pathogen is Fusobacterium necrophorum, but Staph and Strep are also in the mix. The start is with a sore throat, then fevers of 102-105F, 4-5 days later. Then, while the sore throat may lessen, new neck pain, chills, dysphagia, and dyspnea develops, along with malaise and night sweats. Basically, an abscess is forming a suppurative thrombophlebitis of the IJV. The final death knell is usually lung involvement with septic pulmonary emboli.
In summary, the 4 classic Lemierre criteria are:

• recent oropharyngeal infection
• clinical or radiographic evidence of IJV thrombosis
• isolation of anaerobic pathogens
• evidence of at least one septic focus, often the lungs (this means watch out for pleuritic chest pain!)

WHAT do I do in the Express Care with a patient whom I think has Lemierre? Run like hell! No, just kidding.  Lemierre victims emergently need a CT with contrast of the neck and chest to first check the internal jugular vein, and second, to check for pulmonary emboli. Obviously EMS may be needed depending on the patient's appearance and respiratory status.

In summary, most of us when confronted with a "bounceback" sore throat with worse fever and neck pain will think mono, or perhaps even PTA. However, this 3rd option should be kept in your diagnostic acumen!