A 28-year-old female with recurrent ear infections presented with neck pain and hearing loss. The patient endorsed five months of neck pain and one month of left ear pain, ringing, and vertigo. Her exam demonstrated decreased hearing in the left ear and retro-auricular tenderness.
MRI brain showed occlusion of the left internal jugular vein and left sigmoid and transverse sinuses, and otomastoiditis and osteomyelitis of the C1 vertebral body, occipital condyles, and base of the skull and soft tissue abscess formation. CT Chest demonstrated diffuse pulmonary opacities consistent with multifocal pneumonia. Neck abscess biopsy demonstrated non-caseating granulomas and thick-walled budding yeasts consistent with Blastomycoses.
The patient’s course was complicated by intubation and initiation of extracorporeal membrane oxygenation for ARDS. The patient was started on antifungal therapy; therapeutic anticoagulation due to underlying septic thrombophlebitis. The patient improved clinically and was ultimately discharged on long-term antifungal therapy.
The case describes Lemierre syndrome due to blastomycosis, a rarely implicated organism. Prompt diagnosis is essential for prevention of neurologic and systemic complications. The case demonstrates clinicians must maintain a broad differential when managing septic thrombophlebitis involving the cerebral venous system, and consider fungal causes in the appropriate clinical context.