Lemierre syndrome is a rare condition characterized by septic thrombophlebitis of the internal jugular vein with metastatic septic emboli, most commonly affecting the lungs. We report a case of Lemierre syndrome temporally associated with influenza A infection in a previously healthy 21-year-old male. The patient initially presented to the emergency department with severe headache and tested positive for influenza A. Over the following seven days, his symptoms progressed to neck pain with decreased range of motion, hemoptysis, cough, and persistent myalgias. Despite four additional emergency department visits, his evolving neck symptoms were attributed to influenza-related myalgias and cervical strain. On the day of admission, examination demonstrated neck swelling, tenderness, restricted jaw opening, and pink foamy sputum. Laboratory studies were significant for severe thrombocytopenia, lactic acidosis, and sepsis. Imaging revealed right mastoid effusion, paranasal sinusitis, multifocal pneumonia, and a near-occlusive thrombus of the right internal jugular vein. Blood cultures grew beta-hemolytic group C Streptococcus and Peptoniphilus asaccharolyticus. The patient was treated with vancomycin, ceftriaxone, clindamycin, and metronidazole. Anticoagulation was initially deferred because of profound thrombocytopenia. Additional therapies included nebulized tranexamic acid, platelet transfusion, corticosteroids, and intravenous immunoglobulin for suspected immune-mediated thrombocytopenia. His hospital course was complicated by metabolic encephalopathy requiring intubation. The patient improved with treatment and was discharged after 17 days on oral antibiotics and rivaroxaban. He was subsequently readmitted 20 days later with a right empyema requiring bronchoscopy, chemical pleurodesis, and decortication. He has remained free of further hospitalization for one year. This case highlights the diagnostic challenges of Lemierre syndrome and the potential for diagnostic anchoring following an initially confirmed viral diagnosis. Although a causal relationship between influenza A infection and Lemierre syndrome cannot be established, clinicians should reassess the diagnosis when patients with confirmed influenza develop persistent or progressive focal symptoms, particularly neck pain or swelling, restricted jaw opening, respiratory symptoms, or systemic deterioration. Early recognition of Lemierre syndrome and prompt treatment are critical to reducing severe complications and morbidity.

Choline and geranic acid-based ionic liquids (CAGE-IL) have emerged as powerful delivery vehicles for many challenging drug molecules via different routes of administration. However, their potential for aerosol delivery has not been reported. In this study, CAGE-IL is investigated for its ability to solubilise a combination of lapatinib ditosylate (LPT) and resveratrol (RSV) as a potential vehicle for localised delivery in lung cancer therapy. The results showed that CAGE-IL had much higher solubility for LPT (114.6 ± 3.5 mg/mL vs. 0.02 mg/mL) and RSV (58.1 ± 6.8 mg/mL vs. 0.03 mg/mL) than their respective aqueous solubilities, as determined using a validated HPLC method developed for the simultaneous estimation of the molecules. An octanol/water partition coefficient of 2.34 for LPT from LPT-CAGE-IL and 2.18 for RSV from RSV-CAGE-IL was obtained. Upon evaluation in A549, a lung adenocarcinoma cell line, the IC50 value of LPT+RSV-co-loaded CAGE-IL was significantly lower (1.2 times, p˂0.006) than LPT solution (5.3 times, p˂0.0001) or RSV solution (2.7 times, p˂0.001). Importantly, we performed the first nebulization efficiency characterisation for CAGE-IL, obtaining 48 ± 1% for LPT and 49 ± 1% for RSV, with drug output rates of 15 mg/min for LPT and 7 mg/min for RSV and D50 of 2.74 µm. The MMAD, FPF, and GSD were 2.00 ± 0.2 µm, 74 ± 5 %, and 2.48 ± 0.2 for RSV, and 2.10 ± 0.3 µm, 70 ± 7 %, and 2.87 ± 0.2 for LPT showing the suitability of the prepared formulation for pulmonary use. Overall, achieving high solubility of both drugs in a single medium, along with near-identical recovery, signified uniform co-aerosolisation without phase separation during nebulization, indicating CAGE-IL as a possible vehicle for inhalation delivery, and enhance the therapeutic efficacy for localised lung cancer treatment.