A case of Lemierre's syndrome presenting with multiple pulmonary abscesses associated with a tension hydropneumothorax resulting in a mediastinal shift.

INTRODUCTION: We report a case of Lemierre's syndrome.

CLINICAL PICTURE: A previously healthy 36-year-old woman presented with a 2- to 3-month history of fever, cough, dyspnoea and sore throat, which had worsened in the week prior to presentation. Computed tomography of the thorax showed multiple bilateral cavitating lesions and a right-sided hydropneumothorax with mediastinal shift. Blood cultures grew Fusobacterium and Bacteroides species.

TREATMENT: Broad-spectrum antibiotics were commenced, a chest drain was inserted, and the patient was transferred to the intensive care unit due to worsening respiratory failure.

OUTCOME: Despite intensive supportive care with broad-spectrum antibiotics, aggressive fluid resuscitation and high-dose inotropic support, the patient developed acute renal failure, disseminated intravascular coagulation and intractable shock, and succumbed 8 days later.

CONCLUSIONS: Although this condition is uncommon, it should be considered in the differential diagnosis of patients with pulmonary cavitating lesions, especially in the context of fever and rigors preceded by a sore throat.