# Streptococcal Toxic Shock Masking Lemierre's Syndrome

## TL;DR

A woman with streptococcal toxic shock was found to also have Lemierre's syndrome caused by a rare pathogen.

## Contribution

The paper highlights a rare association of group A streptococcus with Lemierre's syndrome.

## Key findings

- The patient presented with septic shock caused by group A beta-hemolytic streptococcus.
- Imaging confirmed internal jugular venous thrombosis, a key feature of Lemierre's syndrome.
- The case emphasizes the need for thorough clinical evaluation in invasive GAS infections.

## Abstract

We report a case of a previously healthy woman presenting with septic shock unresponsive to seven litres of intravenous fluid resuscitation, broad-spectrum antimicrobials, necessitating admission to intensive care. The history and clinical presentation suggested streptococcal toxic shock syndrome (STSS), and group A beta-hemolytic streptococcus (GAS) was isolated from blood cultures. Persisting leg weakness, neck and spinal pain led to an MRI, which showed an inflammatory process on the right side of the neck, confirmed by CT angiogram as right internal jugular venous thrombosis. The triad of cervical lymphadenopathy, internal jugular venous thrombosis and sepsis is a classical feature of Lemierre's syndrome, but here caused by a rarely associated pathogen, namely GAS. Our case illustrates the necessity for investigating all possible foci of invasive GAS (iGAS) and repeating a careful clinical examination if not improving.