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24-year-old woman with a history of intravenous drug use presented with 5 days of fevers, rightsided neck pain, and odynophagia. Physical and laboratory examination revealed tender swelling of the right neck and neutrophil-predominant leukocytosis. Computed tomography demonstrated a large right retropharyngeal fluid collection with associated stranding, right internal and external jugular vein thrombi, and multiple peripheral nodular and wedgeshaped pulmonary opacities representing septic emboli (Fig. 1) consistent with Lemierre’s syndrome. The patient underwent emergent incision and drainage of the abscess and received broad-spectrum antibiotics. Peripheral blood and abscess cultures grew methicillinresistant Staphylococcus aureus (MRSA). The patient was stable postoperatively and completed 4 weeks of intravenous antibiotics. Lemierre’s syndrome is defined by recent history of painful oropharyngeal infection (anginal illness), evidence of metastatic lesions, and either septic internal jugular thrombophlebitis or isolation of Fusobacterium sp. from blood or sterile sites. 1 While classically associated with Fusobacterium necrophorum, 14 cases associated with S. aureus are reported in the literature, with roughly half occurring in young adults under 32 years of age. 2–4 In this case, the patient’s history of intrave

MRSA-Associated Lemierre’s Syndrome in an Intravenous Drug User