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Severe case of Lemierre syndrome with multiple neurological and ophthalmological sequelae
  1. Alice Liu1,
  2. Jemma Taylor1,
  3. Monica Slavin1,2 and
  4. Steven Tong1,3
  1. 1Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
  2. 2Infectious Diseases & Infection Prevention Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  3. 3Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
  1. Correspondence to Dr Alice Liu; alice.junnan.liu{at}


A 56-year-old man was admitted to intensive care with septic shock, multiple facial abscesses and thrombophlebitis of the right internal jugular vein with extensive intracranial extension. A diagnosis of Lemierre syndrome due to Streptococcus anginosus was made and treatment initiated with high-dose ceftriaxone and metronidazole, along with surgical debridement. His admission was complicated by raised intraocular pressures and visual loss requiring bilateral canthotomies. Despite therapeutic anticoagulation with enoxaparin, he also developed an ischaemic basal ganglia infarct. After a prolonged and complex hospital stay, the patient was later readmitted with an intracerebral abscess requiring surgical excision and a second course of antibiotics. This case highlights the value of early recognition of this rare but potentially life-threatening condition, considerations around anticoagulation and antibiotic decisions, and the importance of close multidisciplinary follow-up even after discharge from hospital.

  • infectious diseases
  • adult intensive care
  • neuroimaging
  • haematology (incl blood transfusion)

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  • Contributors AL was responsible for the writing of the case report, literature review and obtaining consent from the patient. JT identified and managed the case as treating registrar, and provided feedback on the manuscript. MS and ST both managed the case as treating consultants and provided detailed feedback on the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

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