# Disseminated Fusobacterium necrophorum Infection Without Jugular Venous Thrombophlebitis: An Atypical Presentation of Lemierre's Syndrome

## TL;DR

A rare case of a severe Fusobacterium infection in a middle-aged man presented without typical symptoms, emphasizing the need for awareness of atypical forms of this disease.

## Contribution

Reports an atypical case of Lemierre's syndrome without pharyngitis or jugular thrombophlebitis, expanding clinical recognition of Fusobacterium infections.

## Key findings

- The patient presented with septic pulmonary emboli, bilateral empyema, liver abscess, and portal vein thrombophlebitis.
- Successful treatment was achieved through early diagnosis and multimodal therapy.
- Atypical presentations of Fusobacterium infections may have higher mortality rates than classic cases.

## Abstract

Lemierre's syndrome is classically characterized by Fusobacterium necrophorum bacteremia with jugular venous thrombophlebitis, typically affecting young adults following oropharyngeal infections. We report an unusual case of disseminated F. necrophorum infection in a 53-year-old man who presented without pharyngitis or jugular venous thrombophlebitis, instead manifesting with septic pulmonary emboli, bilateral empyema, liver abscess, and portal vein thrombophlebitis. This case highlights the importance of recognizing atypical presentations of invasive Fusobacterium infections, which are associated with higher mortality rates compared to classic Lemierre's syndrome. Early diagnosis and aggressive multimodal treatment led to the successful management of this complex case.