Garbati et al. Journal of Medical Case Reports 2012, 6:97 http://www.jmedicalcasereports.com/content/6/1/97 consequences are expected such as the involvement of the sigmoid or cavernous sinuses. Another indication for anticoagulation in patients with LS would be suppur- ating thrombophlebitis of the sigmoid sinus propagating to the cavernous sinus. Conclusions Cases of LS are rare. It may be caused by organisms not originally described by Andre Lemierre. Clinicians should therefore look out for organisms other than F. necrophorum when clinical suspicion is high and also broaden the antimicrobial cover. In all cases reported due to K. pneumoniae, the patients happen to be dia- betic; therefore the question arose as to whether dia- betes mellitus specifically selects for this organism. Available evidence suggests this could be the case. The role of anticoagulation has been controversial and since no randomized trials are available, this approach has only been applied on a case-by-case basis. Accurate and timely diagnosis is critical because untreated disease is usually fatal. Primary care providers should therefore be aware of the syndrome in patients with oropharyngeal infection who subsequently show signs of systemic ill- ness or pulmonary involvement. Consent Written informed consent was obtained from the patient for publication of this case report and any accompany- ing images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Authors’ contributions MAG designed and prepared the manuscript. AMA managed our patient and also reviewed the manuscript. AMH reviewed the manuscript. All authors have read and approved the final manuscript for publication. Competing interests The authors declare that they have no competing interests. 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