Lemierre's syndrome: A rare cause of multifocal infection in an adolescent

Lemierre's syndrome is a rare disease characterized by septic thrombophlebitis of the internal jugular vein with septic emboli causing multifocal infection. This syndrome is most commonly seen after an upper respiratory tract infection in the adolescent population. We present a case of a teenage patient diagnosed with Epstein-Barr Virus (EBV) who presented to our tertiary care facility in multisystem organ failure with initial findings concerning for necrotizing fasciitis of the retroperitoneum. The patient underwent surgical debridement with frank purulence in the retroperitoneal space and emphysematous osteomyelitis of the right ilium. F. necrophorum was isolated from surgical specimens which led to the suspicion of Lemierre's syndrome. Further work up revealed internal jugular vein thrombosis, as well as multifocal inoculation with infection in the ankle, hip, chest, and neck confirming the clinical diagnosis. Lemierre's syndrome is associated with significant morbidity and can be fatal if not promptly recognized and treated. Therefore, early identification is essential to providing appropriate medical and surgical care.