title: A case of Lemierre's syndrome with septic shock and complicated parapneumonic effusions requiring intrapleural fibrinolysis.
abstract: Lemierre's syndrome is a septic thrombophlebitis of the internal jugular vein, which can lead to severe systemic illness. We report a case of an otherwise healthy 26-year-old man who suffered from pharyngitis followed by septic shock requiring intubation and vasopressor support from Fusobacterium necrophorum bacteremia. The septic emboli to his lungs caused complicated bilateral parapneumonic effusions, which recurred after initial drainage. He required bilateral chest tubes and intrapleural tPA to successfully drain his effusions. His fever curve and overall condition improved with the resolution of his effusions and after a 33-day hospitalization, he recovered without significant disability. The severity of his illness and difficult to manage complicated parapneumonic effusions were the unique facets of this case. Using an evidence-based approach of tPA and DNase for complicated parapneumonic effusions in Lemierre's syndrome can be safe and effective.
authors.affiliation: University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Croft
authors.affiliation: University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Philippo
authors.affiliation: University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA.
authors.forename: Paritosh
authors.initials: P
authors.lastname: Prasad
keywords: Chest tube; Critical care; DNase, deoxyribonuclease; ED, Emergency Department; Fibrinolysis; MIST, Multicenter Intrapleural Sepsis Trial; Pleural effusion; Septic thrombophlebitis; Shock; VATS, video-assisted thoracoscopic surgery; tPA, tissue plasminogen activator