This is the EM cases, EM quick hits podcast, where our team of experts and educators bring

you clear, concise, and condensed, practice-changing knowledge on all those EM topics

that you may not be totally comfortable with. Cases, the latest evidence, procedural tips and tricks,

pitfalls to avoid, and the key take-home points and references on the EM cases website.

Quick, let's get on with it. First up, we've got Swami reminding us of some key clinical features

of Lemire's disease. Typically, when we do these EM cases episodes, we talk about a case that we had and then get into the diagnosis and the management. But today, I've actually got a case that I read about, one that I read about in the New England Journal of Medicine. I'm going to read you right from the article. An 18-year-old man presented to the emergency department with a one-week history of sore throat, fever, and malaise, and a three-day history of pleuritic chest pain and productive cough. He reported no history of intravenous drug use, recent travel, or known sick contacts. On examination, he was febrile and ill-appearing and had an oxygen saturation of 88% while breathing ambient air.

Now, that patient is clearly toxic, but the primary presentation here is sore throat and fever.

And pharyngitis, as we know, is a very common presentation to emergency departments and primary care providers.

In fact, in the U.S. alone, there's over

10 million prescriptions of antibiotics for pharyngitis. Now, obviously, that's not all the cases

of pharyngeitis, just the cases that are getting antibiotics. Utility of treatment of

strep throat in developed countries with modern sanitation is debatable. And we've discussed

this in the past on Rebel EM,

and I don't want to get into that today. This, of course, is critical care EM cases, so we're not

going to talk about strep pharyngitis. We're going to get into this case presentation of this

patient. This patient is toxic, much sicker than what we typically see with strep, or even with

a peritonsal or abscess. This patient has a rare,

life-threatening diagnosis, which is Lemmeier's disease. Since we see it so rarely, let's talk about it a bit.

Lemiers is a thromboflobitis of the internal jugular vein with bacteremia, typically from anaerobic bacteria,

most commonly fusobacterium, which is a gram-negative bacillus.

Most cases occur after some other kind of pharyngeal infection or oropharyngeal infection,

and it's most common in kids, young adults, and adolescents.

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