When Shannon Aud, a freshman at Virginia Tech, came home for winter break last December, she was looking forward to a few weeks relaxing with her family, hanging out with her friends and skiing at a West Virginia resort. But on Christmas Eve, when she developed a bad sore throat, Aud figured she'd caught a virus from her boyfriend.
Aud, who had never been seriously ill, expected she would be fully recovered in a few days. She had no inkling that she was about to spend several weeks in the hospital, followed by months recuperating from a disease that was greatly feared 100 years ago but is nearly unknown today.
"At first I was annoyed at losing my Christmas break," recalled Aud, now 19, an international studies major from central Virginia. "Then I remember feeling really bad and that I just wanted to be home. I do know that I could not have gotten through this without my mother. She was there every day."
For Susan Aud, a senior research scientist at the U.S. Department of Education, the events involving her oldest child remain vivid.
"It was just so out of the blue," said Aud, a single mother. "You never want to hear a doctor say, 'In 20 years of practicing medicine, I've never seen this -- and I don't know what it is.' "
Shannon's sore throat was soon eclipsed by a high fever and vomiting. Flu, she thought: crummy timing. Determined not to spoil her family's ski trip, Shannon decided to tough it out. She, her mother and her two younger brothers packed up and left as planned on Dec. 26.
After a day spent sleeping in the condo, Shannon felt worse. Her fever sometimes reached 104 degrees, the right side of her neck was visibly swollen and she had wracking chills. "I would take these scalding baths, but I just couldn't stop shaking," she recalled.
The next day her mother took her to a nearby urgent care center. A doctor gave her a cursory exam and told her she might have strep throat; he prescribed Augmentin, a potent antibiotic. The drug didn't seem to help: Her fever bounced around, sometimes shooting up to 104, at other times dropping to nearly normal, which Shannon hoped might mean she was getting better. The swelling spread to her face.
After her boyfriend arrived, Shannon said she decided to "give it the old college try" and go skiing. While waiting in a lift line on Dec. 29, she passed out. Susan Aud decided the vacation was over. She quickly packed up her family and drove home, dropping off her younger children at the house before making a beeline to an emergency room with Shannon.
Shannon, who was badly dehydrated, was hooked up to an IV. Doctors first believed that a stone might have formed in her salivary gland and become infected or abscessed, which would explain the swelling and fever. A CT scan revealed no stone but something much more alarming: a large blood clot in her jugular vein. None of the doctors seemed to have a clue about what might be causing it, nor, they told her mother, had they ever seen anything similar.
For the next several days, various specialists -- a hematologist; an ear, nose and throat specialist; and an infectious-disease physician -- trooped into her room. They gave her steroids to try to shrink the swelling. She endured painful daily injections of blood thinner into her stomach to dissolve the large clot. Doctors ruled out Epstein-Barr virus, which causes mononucleosis and some forms of cancer, as well as lymphoma.
To Susan Aud, two things were becoming increasingly clear: Doctors were stumped and Shannon was deteriorating.
On Jan. 2, an ear, nose and throat specialist pulled her aside. " 'If it were me, I'd get her out of here,' " he advised, adding that her daughter's illness "has exceeded the capacity of this hospital."
Aud, who had reached the same conclusion, wanted Shannon to go to either the University of Virginia Medical Center in Charlottesville, reasonably close to their home, or Georgetown University Medical Center, not far from her office.
But when she broached the idea to the doctor in charge of Shannon's case, he bristled. "If you want to transfer her," Aud recalls him saying, "you'll have to find a bed and a doctor who'll take her."
Unnerved, Aud picked up the phone and called her uncle, a plastic surgeon in central Illinois. An hour later, the arrangements had been made: Shannon was headed for Georgetown, where she was admitted to the pediatric intensive care unit.
Doctors took a detailed history and began running tests, and the now familiar specialists appeared. Several hours later, Susan Aud recalls, one of the junior doctors arrived with news of a tentative diagnosis.
Infectious-disease specialist Charlotte Barbey-Morel strongly suspected she had Lemierre disease, also known as Lemierre syndrome, an extremely rare complication of a throat infection that tends to affect otherwise healthy teenagers and young adults. Dubbed the "forgotten disease" -- it was once common and killed 90 percent of its victims -- Lemierre's was virtually eradicated by penicillin.