INTRODUCTION: Lemierre's syndrome, an oropharyngeal infection complicated by internal jugular vein thrombosis and metastatic abscesses in lung, is most commonly caused by the anaerobe Fusobacterium necrophorum. No cases, to date, have been found in current literature which document community- acquired Methicillin-resistant Staphylococcus Aureus (CA- MRSA) manifesting as Lemierre's Syndrome.
CASE PRESENTATION: A 37 year old male with history of known IVDA presents with a swollen neck for three days. The patient reported pulling out an ingrown hair on his chin with tweezers one week prior to presentation at which time the patient applied a hot pack to the area, and took some leftover amoxicillin 800mg. The patient then complained of fever, chills, drooling, and dysphonia. A CT scan of the neck demonstrated multiple punctate collections of air within the posterior oropharynx with enlarged right submandibular lymph nodes. The patient's neck swelling became worse and his airway became compromised, necessitating intubation and later a tracheostomy tube was placed. Cultures from I & D of the pharyngeal abscesses isolated CA-MRSA. The patient was then started on vancomycin and remained on ventilator for 2 weeks. A 2D transthoracic Echo was done showing no vegetation on any heart valves and CT of chest showed multiple abscesses in the lung. The patient slowly improved with vancomycin, was extubated and made a full recovery.
DISCUSSIONS: CA-MRSA is becoming more and prevalent in the critical care setting. This is the first documented case of Lemierre's syndrome caused by CA-MRSA that has been found. Lemierre's syndrome is usually caused by the anaerobe Fusobacterium. This presentation of Lemierre's syndrome illustrates the prevalence and variability of CA-MRSA infections.
CONCLUSION: Lemierre's syndrome has never before been documented as being caused by CA-MRSA. As CA-MRSA becomes more prevalent, we may see more unusual presentations of the organism.
DISCLOSURE: Richard Lovy, None.