A sore throat--potentially life-threatening?

Lemierre's syndrome: forgotten, but not absent

Lemierre's syndrome is rare, with no known reported cases in the Caribbean thus far. We highlight a case of a young woman who presented with diabetic ketoacidosis precipitated by oral pharyngeal sepsis, whose condition rapidly deteriorated within 24 hours requiring ventilation and administration of antibiotics. Her sepsis was accompanied by internal jugular vein thrombosis in keeping with a diagnosis of Lemierre's syndrome, which was treated aggressively with antibiotics, intensive care and mechanical ventilatory support in the intensive care unit. She made a full recovery. Though this is the first reported case in the Caribbean of this ‘forgotten disease’, it must not be forgotten because prognosis and outcome are markedly improved with prompt and aggressive treatment.

Just a sore throat? Uncommon causes of significant respiratory disease

We present two uncommon underlying causes of a sore throat which, if missed or delayed in diagnosis, can lead to disastrous consequences. Our first case is of Lemierre's syndrome diagnosed in a 21-year-old man presenting with a 5-day history of sore throat, fever, right-sided pleuritic chest pain and bilateral pulmonary nodules on CT imaging. Fusobacterium necrophorum cultured from peripheral blood and an occluded left internal jugular vein on ultrasound lead to an eventual diagnosis. Our second case presents a 29-year-old woman with a 5-day history of sore throat, fever and right-sided pleuritic chest pain. A left-sided quinsy was diagnosed and aspirated and the patient was discharged home. She represented shortly with worsening pleuritic pain and was found to have a right-sided pleural effusion with descending mediastinitis originating from the tonsillar abscess. Delayed diagnosis resulted in open thoracotomy, decortication and prolonged intravenous antibiotics.