Lemierre syndrome: a rare condition in a pediatric patient

*Correspondence: [e-mail].

Abstract

Case Presentation: Male, 15-year-old black boy. By the end of March 2023, he had a sore throat, fever and malaise. Over the next few days, he developed headache, bipalpebral edema, pain and swelling over his neck, vomiting, shortness of breath and desaturation. Contrast-enhanced CT of the head, neck, and chest were performed and revealed pneumocephalus, abscess in the left frontal lobe of the brain, superior sagittal sinus thrombosis, thrombus along the internal jugular veins causing septic thrombophlebitis, ground-glass opacities and consolidations in the lung, consistent with Lemierre's syndrome. Blood cultures were negative, but the culture of drainage of maxillary sinus were positive Acinetobacter baumannii complex and Streptococcus anginosus multissensible and after one week the drainage of orbital cellulitis was performed and positive for Staphylococcus Haemolyticus, multiresistant. Intravenous ceftriaxone, metronidazole and anticoagulation with low molecular weight heparin was initiated, but the antibiotics were replaced by linezolid and meropenem, directed by antibiogram. Neurosurgeons recommended craniotomy with drainage due to brain abscess, with no intercurrence. The patient's clinical status improved after the implemented measures.

Discussion: Lemierre syndrome (LS) is a rare condition characterized by septic thrombophlebitis of the internal jugular vein, with septic embolization, leading to multiorgan involvement, commonly the lungs (up to 97% of cases). Its incidence has been between 0.6-2.3 per million people. There is a male predominance, with 70% of patients between the ages of 16 and 25 years. The most common site of infection is the palatine tonsils (87.1% of cases), as is our case. Clinical manifestations include fever, pain and stiffness of the neck and cervical lymphadenopathy, trismus. Fusobacterium necrophorum is responsible for a majority of cases, but in up to one-third of patients polymicrobial bacteremia is demonstrated. Contrast-enhanced CT is considered gold standard. The treatment is usually with anticoagulation, intravenous antibiotics for 3-6 weeks and potentially surgical drainage for non-resolving abscesses.

Final Comments: LS is a rare disease associated with potentially life-threatening complications. It is important to recognise the symptoms early, appropriate treatment confers a very good prognosis, while its late complications are catastrophic with multiorgan involvement.

Publication History

Article published online:
12 May 2025