Neck Pain, or Just a Pain in the Neck?

This is a case of a 13-year-old boy with a 2 day history of right shoulder pain and fever, progressing to include neck pain and stiffness. The patient had soft tissue swelling and tenderness over his shoulder and sternoclavicular joint, and was admitted to the intensive care unit due to signs of sepsis. CT and MRI imaging demonstrated multiple nodular densities in the lungs, local cellulitis, myositis and osteomyelitis at the shoulder and clavicle, and a flow void in the right internal jugular vein, consistent with Lemierre syndrome. Blood cultures revealed MRSA as the causative organism.