LEMIERRES SYNDROME - ARE WE UNDERDIAGNOSING THIS LIFE-THREATENING INFECTION

Over a period of 12 months 3 patients presented with severe tonsilliti s and subsequently grew Fusobncterium necrophorum (literally - spindle -shaped rod which brings death!) from blood cultures. Two patients res ponded well to antibiotics and were discharged within 4 days of admiss ion. The third case had a longer history of symptoms and following inv estigations of a minor but unusual neck swelling was found to have thr ombosis of the external and internal jugular vein. This is the first s tage in the potentially fatal dissemination of this virulent organism which manifests clinically as Lemierre's syndrome. We describe the cli nical histories and discuss whether cases are unrecognised because of the prompt clinical response to penicillin and metronidazole. We stres s the importance of taking blood cultures and careful examination of t he neck in all patients presenting with a severe tonsillitis.