We report a case of Lemierre Syndrome caused by Arcanobacterium haemolyticum bacteremia in a previously healthy immunocompetent 29-year-old male. Two blood cultures revealed the exclusive presence of A. haemolyticum.

A 29-year-old male with no past medical history presented with a 5-day history of fever, chills, and severe odynophagia. Physical exam revealed asymmetrical tonsillar swelling and a CT Neck with contrast showed an infectious process surrounding the left palatine tonsil and inflammatory phlegmonous changes and gas abutting the left carotid sheath. Given this, patient was to be transferred to a tertiary care center for further evaluation by ENT. His symptoms continued to worsen, and he presented to the tertiary care center the following day. Initially, the patient was afebrile with a leukocytosis 13.5. A CT neck showed an infectious abscess around the left parapharyngeal and left carotid spaces with thrombophlebitis of the left internal jugular vein with complete thrombosis suggestive of Lemierre’s syndrome. Septic emboli were also noted in the upper lungs. Antibiotics were broadened to linezolid and piperacillin-tazobactam. The patient was taken to the OR for left neck exploration, left peritonsillar abscess drainage, and excision of the left jugular vein. During the procedure, it was noted that the thrombosed internal jugular vein had purulent material expressed. Two blood cultures were positive exclusively for Arcanobacterium haemolyticum at 3.6 days and the BCID panel was negative for all targets including Streptococcus. Intra-operative cultures had no growth. His leukocytosis gradually returned to normal range, and he remained afebrile. Patient was discharged with plan for 2 weeks of IV ampicillin-sulbactam and 4 additional weeks of PO amoxicillin/clavulanate.

In 1936, Andre Lemierre described a series of cases of septicemia caused by Fusobacterium necrophorum and complicated with internal jugular vein thrombophlebitis and septic emboli to distant organs. F. necrophorum is the most common causative agent of Lemierre’s syndrome, followed by Fusobacterium nucleatum. Lemierre's syndrome is a rare condition, estimated to affect approximately one in a million individuals annually. Typically, affected individuals are young, previously healthy adults, with a male-to-female ratio of 2:1. To date, only 6 cases of Lemierre’s syndrome caused exclusively by A. haemolyticum have been reported in the medical literature and no cases have been reported from the United States. We present the first case of Lemierre's disease stemming from infection solely involving A. haemolyticum.