# Intractable Pyopneumothorax due to Lemierre's Syndrome Treated With an Endobronchial Watanabe Spigot (EWS)

## TL;DR

A rare case of Lemierre's syndrome with severe lung complications was successfully treated using a minimally invasive endobronchial device, avoiding surgery.

## Contribution

This is the first reported case of Lemierre's syndrome treated with an endobronchial Watanabe spigot (EWS), demonstrating its effectiveness.

## Key findings

- Lemierre's syndrome was complicated by pyothorax and intractable pneumothorax in a 29-year-old woman.
- Endobronchial Watanabe spigot (EWS) resolved persistent air leakage without requiring surgery.
- EWS proved effective as a minimally invasive treatment for refractory pulmonary complications in this case.

## Abstract

Lemierre's syndrome is a rare condition characterised by internal jugular vein thrombophlebitis and bacteremia caused by anaerobic organisms following an oropharyngeal infection. We report the case of a 29‐year‐old woman who presented with fever, sore throat, dyspnea, and chest pain. Chest computed tomography (CT) revealed lung suppuration, pneumothorax, and thrombosis of the left internal jugular vein, confirming the diagnosis of Lemierre's syndrome. During treatment, she developed pyothorax with bronchopleural fistulas and intractable pneumothorax. Although antibiotics and thoracic drainage controlled the infection, persistent air leakage and incomplete lung expansion remained. Placement of an endobronchial watanabe spigot (EWS) successfully resolved the air leak, allowing the patient to avoid surgery and be discharged. This case highlights the effectiveness of EWS in managing intractable pyopneumothorax secondary to Lemierre's syndrome.

This manuscript reports a rare case of Lemierre's syndrome complicated by pyothorax with bronchopleural fistulas and intractable pneumothorax in a 29‐year‐old woman. Despite infection control with antibiotics and thoracic drainage, persistent air leakage required intervention with endobronchial watanabe spigots (EWS), which successfully resolved the air leak and avoided surgery. This is the first reported case of Lemierre's syndrome treated with EWS, highlighting its effectiveness as a minimally invasive option for managing refractory pulmonary complications.