Classical Lemierre's syndrome is characterized by severe sepsis with metastatic 
abscess formation in young, previously fit people from a primary head or neck 
focus. The causative organisms are the anaerobic fusobacteria, most commonly 
Fusobacterium necrophorum. We describe the evaluation, therapeutic interventions 
and management of a patient with Lemierre's syndrome who presented in septic 
shock with multiple organ dysfunction. The patient required immediate 
interventions including endotracheal intubation and mechanical ventilation, 
fluid resuscitation, inotropic support, bilateral thoracostomy tube drainage of 
empyemata and antimicrobial therapy. The unexpected isolation of Fusobacterium 
necrophorum from blood cultures and empyema fluid necessitated a change of 
antibiotic regime to provide anaerobic cover. The patient required 4 weeks of 
intensive support including prolonged antimicrobial therapy, and after a further 
2 weeks was discharged home from hospital. This case highlights the need to 
raise the awareness of 'the forgotten disease': Lemierre's syndrome. Its 
diagnosis may, as in this case, be confounded by a lack of symptoms of 
pharyngitis at the time of presentation, and end-organ dysfunction associated 
with severe sepsis, possibly suggesting an alternative source of infection. As 
appropriate antibiotics reduce mortality dramatically, clinicians need to be 
alert to Lemierre's syndrome and include it in the differential diagnosis in 
young but otherwise healthy patients presenting with severe sepsis.