Lemierre Syndrome

A sore throat that improves and then gives way to rigors, unilateral neck pain, or pleuritic chest pain is not behaving like uncomplicated pharyngitis. This progression suggests that an oropharyngeal infection may have spread into a neck vein, producing bacteremia and septic emboli. That syndrome is Lemierre syndrome, a time-sensitive infection in which the nurse must recognize sepsis while the diagnostic workup is still underway. The immediate priorities are to assess airway, breathing, circulation, and mental status; obtain blood cultures without meaningfully delaying treatment; begin ordered empiric antimicrobial therapy with reliable anaerobic coverage; and identify abscesses or other collections that require drainage. A low score for group A streptococcal pharyngitis does not rule out Fusobacterium necrophorum or Lemierre syndrome.