A College Football player’s battle with a forgotten disease Krishna Khanal, MD SIU School of Medicine Quincy, IL

History 20 yo previously healthy w/ neck pain, swelling, cough and dysphasia for 2 wks. Recently treated for sore throat with azithromycin and doxycycline. Normal cervical CT exam one week prior.

Physical Examination Toxic, on moderate distress. Pulse oxymetry of 94% at room air with recent weight loss. Enlarged tonsils with exudates. Tender, soft to firm mobile mass in the rt. submandibular area. Diminished breath sounds on B/L lung bases.

Differential Diagnosis Tonsillitis Soft tissue neck abscess Pneumonia Infectious mononucleosis Submandibular Sialadenitis TB/Atypical Mycobacteria Hodgkin’s Lymphoma

Laboratory Evaluation WBC Count 20.8 (Bands:18%) Normal blood chemistries, cardiac enzymes, LFT, HIV and hepatitis panels. CXR: Bibasilar consolidation with pulmonary infiltrates. CT neck and chest: Occlusion of internal jugular vein due to thrombus, multiple cervical lymph node swellings, bibasilar pulmonary infiltrates. Culture: Fusobacterium necroforum.

CT Neck

Final Diagnosis Lemierre’s Disease (Forgotten Disease)

Treatment I and D. IV antibiotics Anticoagulation Others: Symptomatic management.

Outcome Patient improved dramatically. Discharged on 10th day. Received total 6 wks of iv antibiotics. CT neck after 4 wks showed resolution of thrombosis.

Return to play Patient was seen once after 4 wks of discharge with resolution of symptoms. Football season was over and he decided to go home. After that lost follow up.

Acknowledgement James Daniels, MD MPH Program Director SIU Primary Care Sports Medicine Fellowship Quincy, IL

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