After initial evaluation, the patient was directly admitted to the inpatient unit for further work up. Laboratory data were significant for total white count of 20,800 per microliter (Bands 18%). Blood chemistries, cardiac markers and liver functions were normal. HIV and hepatitis panels were negative. His blood gas study showed metabolic alkalosis with base excess of 9.8. CMV IgM and EBV IgG titers were positive. His EKG was normal. A chest X-ray showed bibasilar consolidation with pulmonary infiltrates more on the rt. side, likely due to pneumonia. To correlate the neck examination finding and chest X-ray results, a CT of the neck and chest was performed and showed occlusion of the internal jugular vein from the level of the thyroid to the skull base, no evidence of pulmonary embolism, bibasilar pulmonary infiltrates with consolidation, and hepatosplenomegaly. He went for incision and drainage of the neck abscess twice. Gram stain of the pus showed gram negative rods. Acid-fast bacillus and fungal stains and cultures were negative. An anaerobic culture of the pus confirmed growth of the Fusobacterium Necroforum four days after admission. This confirmed a rare diagnosis of Lemierre's disease.
An ear, nose, and throat (ENT) surgeon, cardiologist, hematologist-oncologist, and an infectious disease specialist were consulted.
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