Thoughts on a 23-year-old athlete dying from the Lemierre Syndrome

K-State football team to honor rower Samantha Scott, who died of Lemierre’s Syndrome  Every time I read such a story my heart breaks, a small piece each time. More physicians have become aware of the Lemierre syndrome. We must also educate patients and families that sore throats in adolescents and young adults can become life threatening. Why did she die?  The article does not have enough detail to develop a firm conclusion.  I can speculate on several reasons from multiple discussions with both survivors and families of adolescents who died.  We also have some unpublished survey data that informs my speculations. What do we know?  Fusobacterium necrophorum is the predominant bacteria leading to the syndrome.  Dr. Lemierre, in his classic description of the syndrome that now bears his name, noted that patients usually start with a sore throat.  Over the next 5 days (or so) the symptoms often get worse, with two major clues – unilateral neck swelling (from the suppurative internal jugular thrombophlebitis) and rigors.  In our survey 90% of survivors had rigors prior to diagnosis.  We assume that the rigors are a response to bacteremia. A significant number of survivors did get antibiotics to treat their sore throat.  Most report taking azithromycin (a Zpack).  Fusobacterium necrophorum is a gram negative anaerobe that almost always is resistant to azithromycin. Some patients delay seeking medical care assuming that the “just have a sore throat”.Â...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs