Streptococcus constellatus-Associated Lemierre Syndrome Presenting With Cavitating Septic Pulmonary Emboli Managed by Video-Assisted Thoracoscopy.
Andre Fierro-Mosquera, Camila Perez-Guerron, Jordan Llerena-Velastegui et al.
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Case in brief
A previously healthy 25-year-old man presented with a week of dyspnea, productive cough, fever, and hemoptysis, with severe hypoxemia and respiratory distress. Chest CT showed bilateral cavitating septic pulmonary emboli and necrotizing infection; cervical vascular imaging demonstrated left internal jugular vein thrombosis. A blood culture grew penicillin- and ceftriaxone-susceptible Streptococcus constellatus, while sputum and pleural cultures were sterile. He required intensive care, intravenous antibiotics, anticoagulation, and two video-assisted thoracoscopic procedures for empyema and a later pulmonary abscess. After four weeks of intravenous antibiotics, he improved and was discharged on anticoagulation, asymptomatic at short-term follow-up.
What made this case unusual
The presentation was dominated by severe thoracic sepsis and cavitating lung lesions, with Lemierre syndrome associated with S. constellatus rather than the historically typical Fusobacterium necrophorum; pharyngeal symptoms were absent.
Diagnostic / clinical pearl
In a young adult with severe sepsis and multifocal cavitating pulmonary lesions, consider Lemierre syndrome and assess for internal jugular vein thrombosis even when pharyngeal symptoms are absent.