Lemierre syndrome should be considered in young adults with severe sepsis and multifocal cavitating lung lesions, even without pharyngeal symptoms, and once penicillin-susceptible Streptococcus constellatus is confirmed with no co-pathogen, de-escalation to targeted beta-lactam therapy plus drainage of empyema or abscess should be considered.
A previously healthy 25-year-old man developed Lemierre syndrome caused by Streptococcus constellatus, presenting with predominantly thoracic sepsis rather than pharyngeal symptoms.
Imaging showed bilateral cavitating septic pulmonary emboli with necrotizing pulmonary infection and confirmed left internal jugular vein thrombosis.
Microbiological diagnosis relied on a single positive blood culture; other cultures were sterile.
The patient required intensive care, intubation, broad-spectrum antibiotic escalation, anticoagulation, and two video-assisted thoracoscopic procedures.
The patient improved with 4 weeks of intravenous antibiotics and was discharged on a direct oral anticoagulant, remaining asymptomatic at short-term follow-up.
The authors conclude that Lemierre syndrome should be suspected in young adults with severe sepsis and multifocal cavitating lung lesions even without pharyngeal symptoms.
The authors recommend initial empiric coverage of oral aerobes and anaerobes, then de-escalation to targeted beta-lactam therapy once penicillin-susceptible S. constellatus is confirmed without a co-pathogen.
This case report describes a healthy 25-year-old man in Ecuador who became severely ill with fever, cough, coughing up blood, and very low oxygen levels. Scans showed multiple cavities in both lungs caused by infected blood clots, and a clot in a neck vein. This combination is called Lemierre syndrome, a rare condition where an infection spreads to a neck vein, forms a clot, and sends infected fragments to the lungs. The bacterium found was Streptococcus constellatus, not Fusobacterium, the germ more typically linked to this syndrome. He needed intensive care, a breathing tube, strong antibiotics, blood thinners, and two minimally invasive chest surgeries to drain pus collections. After four weeks of intravenous antibiotics he recovered and went home on a blood thinner pill for another month, and he was symptom-free at short-term follow-up. This research suggests doctors should think of Lemierre syndrome in young adults with severe infection and multiple cavitating lung lesions, even without a sore throat. It also suggests that once the bacterium is identified as penicillin-sensitive and no other germs are found, treatment may be narrowed to targeted antibiotics such as penicillin G or ceftriaxone, along with draining any pus. As a single case report, it cannot show how common or how effective these approaches are in general.
Fierro-Mosquera A, Perez-Guerron C, Llerena-Velastegui J, Jimbo-Sotomayor R, Sanchez X. (2026). Streptococcus constellatus-Associated Lemierre Syndrome Presenting With Cavitating Septic Pulmonary Emboli Managed by Video-Assisted Thoracoscopy.. The American journal of case reports. https://doi.org/10.12659/AJCR.953543