Learning Objectives: We aim to identify early features common to cases of Lemierre's syndrome to facilitate prompt diagnosis and treatment.

Introduction: Lemierre's syndrome is an uncommon, but potentially deadly, complication of common infections of the throat and ear involving thrombophlebitis of the internal jugular vein. Oropharyngeal and auricular infections are some of the most commonly presenting illnesses so physicians must be aware of this diagnosis. However it may be easily missed as early signs are often subtle and non-specific.

Methods: We highlight the difficulty faced in the diagnosis of Lemierre's by presenting the case of a 15 year old boy admitted with sepsis from chronic otitis media, alongside a review of the literature.

Results: As seen with our patient, a common theme in cases of Lemierre's is late diagnosis. He was found to have septic pulmonary emboli on CT pulmonary angiogram after developing breathlessness. From our literature review, the features that can aid early recognition include; headache, neck ache, tenderness over sternocleidomastoid muscle, trismus, chest crepitations and Fusobacterium grown from blood cultures. Later signs include dyspnoea, desaturations, pleuritic chest pain and other signs of septic pulmonary emboli which prompt chest imaging.

Conclusions: Due to the potentially fatal consequences of Lemierre's syndrome, a high index of suspicion should be applied to patients with oropharyngeal or ear infections where symptoms do not settle with 24 hours of antibiotics or where pain, trismus or chest symptoms and signs are seen. We recommend the use of CT or US to screen for IJV thrombosis earlier in the clinical course of these infections.