Abstract
The use of anticoagulation therapy for Lemierre's syndrome remains controversial. Nonetheless, this treatment is relatively common and has been reported as safe with no attributed bleeding complications. We present a rare case of a patient who developed massive pulmonary hemorrhage during treatment with anticoagulation therapy for Lemierre's syndrome. A previously healthy 18-year-old woman presented with fever, neck pain, and worsening dyspnea following symptoms of acute pharyngitis. CT scans of the neck and chest taken on admission to a hospital revealed thromboses of the left facial vein and left internal jugular vein and diffuse pulmonary emboli. A blood culture grew Fusobacterium necrophorum. In addition to antibiotic therapy, anticoagulation therapy with enoxaparin was initiated. On hospital day 7, enoxaparin was replaced with rivaroxaban. On day 11, the patient experienced massive pulmonary hemorrhage, for which she required massive transfusions and endotracheal intubation with subsequent mechanical ventilation. The risk of pulmonary hemorrhage must be weighed against the potential benefits when starting anticoagulation therapy in patients with Lemierre's syndrome having substantial pulmonary emboli.
