Instructive case:: Lemierre syndrome due to non-multiresistant methicillin-resistant Staphylococcus aureus

In disseminated and persistentStaphylococcus aureus infection, it is important to investigate for underlying endovascular infection. Cerebrospinal fluid pleocytosis in the presence of a sterile culture without preceding antibiotic therapy may be due to a parameningeal focus. Lemierre syndrome is characterized by septic thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection. Infections from the oropharyngeal and surrounding structures spread to the parapharyngeal space resulting in thrombophlebitis of the internal jugular vein. Metastatic infections may involve distant organs, particularly the lungs. Fusobacterium necrophorum is the commonest organism found in Lemierre syndrome (70%). Other organisms, e.g. Staphylococcus aureus,Streptococcus spp. andBacteroides spp. are less common. Community-acquired non-multiresistant MRSA is now an increasingly common pathogenic organism and failure to treat early with appropriate antibiotics can lead to serious complications.