A young woman with a sore throat, septicaemia, and respiratory failure

and characterised by intense and sudden thoracic pain, dyspnoea, and haemoptysis; suppurative arthritis; jaundice; albuminuria with increased blood urea; F necrophorum identified from blood cultures and metastatic infections; and leucocytosis and anaemia. In his review, the disease resulted in death within 1 to 2 weeks. In 1989, Sinave et al reviewed 38 cases of Lemierre syndrome. The median age was 20 years, 97% had pleuro-pulmonary involvement, six had septic arthritis, four had soft-tissue abscesses, 15 developed abnormal liver-function results, four became jaundiced, and two died of overwhelming septicaemia despite antibiotic therapy. Management includes surgical incision and drainage, long-term intravenous antibiotics, and anticoagulation. F necrophorum is usually sensitive to the penicillins, clindamycin, metronidazole, and chloramphenicol. Anticoagulation remains controversial because no studies with anticoagulation on septic thrombosis of the internal jugular vein have been done. The use of steroids in the management of this syndrome has not been studied and there is no evidence to suggest a beneficial effect. The majority of patients treated with appropriate antibiotics have a good prognosis, but delayed treatment is associated with poorer outcomes. Leugers et al identified two deaths among eight patients in whom antibiotic therapy was delayed more than 4 days compared with one death in 29 patients who were treated promptly. The death of our patient can be related to her advanced disease at presentation with multiple abscesses and a necrotic iliac crest. The marked decrease in reported cases of Lemierre syndrome in the post-antibiotic era is presumably related to early empirical use of penicillins in the treatment of pharyngitis. Lemierre himself pointed out that the clinical findings alone, “constitute a syndrome so characteristic that mistake is almost impossible”. However, in the post-antibiotic era, this rare, lethal, but curable complication of a common illness may not be considered.