DISCUSSION: Lemierre's syndrome is a life threatening condition associated with significant morbidity and mortality. It is typically preceeded by oropharyngeal infections and classically caused by Fusobacterium necrophorum. Our case is atypical in several ways, with no involvement of oropharynx at any point. The most likely source of his infection, which was caused by CA-MRSA, appeared to be his facial skin infection. This organism is rarely associated with this syndrome with few cases reported in the literature. The occurrence of bilateral, recurrent, refractory pneumothoraces also appears to be very rarely associated with this syndrome, even though septic pulmonary emboli are the most common metastatic complication of the disease. At the end, our patient's clinical deterioration was mostly driven his worsening respiratory status and inability to effectively ventilate him.