Lemierre’s Syndrome Presenting as Acute Respiratory Distress Syndrome after Palpitis Odontogenic Infection: A Case Report

Introduction: Lemierre’s syndrome, is one of forgotten diseases primarily caused by anaerobes Fusobacterium species, with possible other unusual organisms. It occurs after the extension of oropharyngeal infection into pharyngeal spaces of the neck with subsequent septic embolism to different parts of the body. Case: A case described is of a 36-year-old male who presented with neck pain and swelling and five weeks later developed fever, hemoptysis and acute respiratory distress syndrome. A chest radiograph showed diffuse bilateral infiltrate with consolidation and CT-scan chest with extension to the neck revealed dilated IJV with soft tissue swelling. Sputum culture was positive for Pseudomonas aeruginosa, rarely implicated to cause Lemierre’s syndrome. The patient was treated with anticoagulant and intravenous antibiotic therapy with a good response although developed dysphagia as a complication. Conclusion: Lemierre’s syndrome can present atypically with ARDS. High index of suspicion is needed with assistance from microbiological and radiological investigations. Management can be challenging in low resource setting causing major implications in antimicrobial stewardship and proper antimicrobial use, management costs and patient outcome.