Lemierre's syndrome is a severe complication of Fusobacterium necrophorum oropharyngeal
infection associated with metastatic foci of
infection, internal jugular vein
thrombosis, and
septicemia. Musculoskeletal manifestations include isolated or multifocal
septic arthritis, soft tissue
abscesses,
pyomyositis, and
osteomyelitis. This article describes a case of a variant of
Lemierre's syndrome in a 17-year-old girl, demonstrating a relentless case of limb
infection refractory to multiple surgical
debridements and broad-spectrum and targeted
antibiotics. The patient had F. necrophorum within a
peritonsillar abscess and multiple foci within her right lower extremity. Overall, she required 12
surgical procedures and 14 weeks of
antibiotic therapy to resolve the
infection. Further unique findings in this case include the presence of a recent lateral meniscus tear with associated
hemarthrosis treated with a short course of oral
steroids prior to the diagnosis of
septic arthritis. Knee arthroscopy with lysis of adhesions and manipulation at 6 months postinfection demonstrated significant chondral damage. Outcome at >2-year follow-up revealed
pain-free activities of daily living and the ability to return to competitive, club-level collegiate softball. Clinically relevant findings illustrated in this case include potential development of antibiotic resistance within Fusobacterium genus with little to no response to several surgical
debridements and broad-spectrum and targeted
antibiotics, and development of multifocal, ipsilateral
septic arthritis and soft tissue
abscesses and
pyomyositis in the context of
steroid use and recent intra-articular
knee injury.