An Old Disease Makes a Comeback.
A 15-year-old African-American female was hospitalized following 7 days of fever, pharyngitis, and neck pain. Physical exam revealed enlarged tonsils. A rapid group A streptococcus antigen test was negative, and the throat culture showed no streptococci. The blood culture grew Fusobacterium necrophorum. Lumbar puncture results were negative. Chest CT scan showed apical cavitary lesions of the lungs. Doppler and CT scan of the neck showed narrowing of the right internal jugular vein, compatible with thrombophlebitis. The diagnosis of Lemierre's disease was made and patient improved rapidly following intravenous therapy of clindamycin, ceftriaxone, and heparin.
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