Streptococcus constellatus–Associated Lemierre Syndrome Presenting With Cavitating Septic Pulmonary Emboli Managed by Video-Assisted Thoracoscopy
- 1Pontificia Universidad Católica del Ecuador, Quito, Ecuador
- 2Centro de Investigación para la Salud en América Latina (CISeAL), Quito, Ecuador
Abstract
Patient: Male, 25-year-old
Final Diagnosis:
Streptococcus constellatus
-associated Lemierre syndrome with left internal jugular vein thrombosis, cavitating septic pulmonary emboli, empyema, and pulmonary abscess
Symptoms: Dyspnea • fever • hemoptysis • productive cough
Clinical Procedure: —
Specialty: General and Internal Medicine
Objective: Rare disease
Background: Lemierre syndrome is a rare septic thromboembolic disorder. Although historically associated with Fusobacterium necrophorum, non-fusobacterial cases caused by Streptococcus constellatus can present with dominant thoracic sepsis and delayed recognition.
Case Report: A 25-year-old previously healthy man from northern Ecuador presented with 7 days of dyspnea, productive cough, fever, and hemoptysis, with profound hypoxemia and respiratory distress. Chest computed tomography showed bilateral cavitating septic pulmonary emboli and necrotizing pulmonary infection, and cervical vascular imaging confirmed left internal jugular vein thrombosis. One blood culture set grew Streptococcus constellatus susceptible to penicillin and ceftriaxone; sputum and pleural fluid cultures were sterile. He required intensive care, endotracheal intubation, empiric piperacillin-tazobactam plus vancomycin, escalation to meropenem plus vancomycin during clinical deterioration while resistant or polymicrobial infection was considered, therapeutic anticoagulation, and 2 video-assisted thoracoscopic procedures for empyema and a subsequent pulmonary abscess. After 4 weeks of intravenous antibiotics, he improved and was discharged on a direct oral anticoagulant for 1 additional month, remaining asymptomatic at short-term follow-up.
Conclusions: Lemierre syndrome should be considered in young adults with severe sepsis and multifocal cavitating lung lesions, even without pharyngeal symptoms. Empiric therapy should initially cover oral aerobes and anaerobes; once penicillin-susceptible Streptococcus constellatus is confirmed and no co-pathogen is recovered, de-escalation to targeted beta-lactam therapy, such as penicillin G or ceftriaxone, should be considered together with drainage of empyema or abscess when present.
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BibTeX
@article{fierromosquera2026streptococcus,
title = {{Streptococcus constellatus–Associated Lemierre Syndrome Presenting With Cavitating Septic Pulmonary Emboli Managed by Video-Assisted Thoracoscopy}},
author = {Andre Fierro-Mosquera and Camila Perez-Guerron and Jordan Llerena-Velastegui and Ruth Jimbo-Sotomayor and Xavier Sanchez},
journal = {The American Journal of Case Reports},
year = {2026},
month = oct,
doi = {10.12659/ajcr.953543},
url = {https://doi.org/10.12659/ajcr.953543},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Streptococcus constellatus–Associated Lemierre Syndrome Presenting With Cavitating Septic Pulmonary Emboli Managed by Video-Assisted Thoracoscopy
AU - Andre Fierro-Mosquera
AU - Camila Perez-Guerron
AU - Jordan Llerena-Velastegui
AU - Ruth Jimbo-Sotomayor
AU - Xavier Sanchez
PY - 2026
DA - 2026/10/23
JO - The American Journal of Case Reports
DO - 10.12659/ajcr.953543
UR - https://doi.org/10.12659/ajcr.953543
AB - Patient: Male, 25-year-old Final Diagnosis: Streptococcus constellatus -associated Lemierre syndrome with left internal jugular vein thrombosis, cavitating septic pulmonary emboli, empyema, and pulmonary abscess Symptoms: Dyspnea • fever • hemoptysis • productive cough Clinical Procedure: — Specialty: General and Internal Medicine Objective: Rare disease Background: Lemierre syndrome is a rare septic thromboembolic disorder. Although historically associated with Fusobacterium necrophorum, non-fusobacterial cases caused by Streptococcus constellatus can present with dominant thoracic sepsis and delayed recognition. Case Report: A 25-year-old previously healthy man from northern Ecuador presented with 7 days of dyspnea, productive cough, fever, and hemoptysis, with profound hypoxemia and respiratory distress. Chest computed tomography showed bilateral cavitating septic pulmonary emboli and necrotizing pulmonary infection, and cervical vascular imaging confirmed left internal jugular vein thrombosis. One blood culture set grew Streptococcus constellatus susceptible to penicillin and ceftriaxone; sputum and pleural fluid cultures were sterile. He required intensive care, endotracheal intubation, empiric piperacillin-tazobactam plus vancomycin, escalation to meropenem plus vancomycin during clinical deterioration while resistant or polymicrobial infection was considered, therapeutic anticoagulation, and 2 video-assisted thoracoscopic procedures for empyema and a subsequent pulmonary abscess. After 4 weeks of intravenous antibiotics, he improved and was discharged on a direct oral anticoagulant for 1 additional month, remaining asymptomatic at short-term follow-up. Conclusions: Lemierre syndrome should be considered in young adults with severe sepsis and multifocal cavitating lung lesions, even without pharyngeal symptoms. Empiric therapy should initially cover oral aerobes and anaerobes; once penicillin-susceptible Streptococcus constellatus is confirmed and no co-pathogen is recovered, de-escalation to targeted beta-lactam therapy, such as penicillin G or ceftriaxone, should be considered together with drainage of empyema or abscess when present.
SN - 1941-5923
ER -