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A5675 - Stick Your Neck Out for Lemierre’s Syndrome
Author Block: C. Browning1, S. Meledathu2; 1Pediatrics, Children's Hospital of New Jersey at Newark Beth Israel Medical Center, Newark, NJ, United States, 2Internal Medicine-Pediatrics, Children's Hospital of New Jersey at Newark Beth Israel Medical Center, Newark, NJ, United States.
Introduction: Lemierre’s syndrome is septic thrombophlebitis of the internal jugular vein commonly caused by organisms from the oropharynx. We present a case of Lemierre’s syndrome that was preceded by Mycoplasma pneumoniae, a rare presentation with this organism. This case demonstrates the importance of prompt recognition of Lemierre’s syndrome as a serious complication of untreated Mycoplasma, particularly in this age group.
Case presentation: 18 year old Caucasian male with history of childhood epilepsy presented with a one week history of fever, severe sore throat, and cervical lymphadenopathy. He was admitted to the pediatric intensive care unit for intermittent fevers and respiratory distress requiring respiratory support with high flow nasal cannula. The patient was initially septic with maximum temperature of 105F, tachycardia, tachypnea, leukocytosis with bandemia, and laboratory values consistent with disseminated intravascular coagulation. Chest x-rays revealed worsening pleural infiltrates, effusions, nodular densities, and cavitary lesions which were confirmed by spiral computed tomography. Due to the severe nature of his pulmonary lesions, patient had an echocardiogram which revealed trivial pericardial effusion with no vegetations and had upper extremity dopplers which demonstrated thrombus of the left internal jugular vein consistent with Lemierre’s syndrome with septic emboli to the lung. The initial viral respiratory panel was negative, but the findings on imaging prompted serological analysis which was positive for active mycoplasma infection with elevated IgM levels and positive cold agglutinins. Due to clinical improvement and resolving lesions on imaging, the patient did not require surgical intervention and was discharged home with peripherally inserted catheter and IV antibiotics.
Discussion: Lemierre’s syndrome has been described as a complication of pharyngitis predominantly in the pre-antibiotic era, but the incidence is greatly reduced with the diligent treatment of oropharyngeal infections with modern medicine. This disease is uncommon in the pediatric and adolescent populations which may delay the diagnosis. Diagnosis is typically made through computed tomography, but ultrasound can be utilized to visualize the structures. Treatment includes prolonged IV antibiotics and surgery is based on the severity and invasion of disease. There have been a few case reports regarding Lemierre’s syndrome with preceding viral infections and are typically found in correlation with Fusobacterium. To our knowledge, there has been only three case reports identifying Mycoplasma pneumoniae as a preceding infection Lemierre’s syndrome. We hope that this case report will aid in prompt diagnosis of Mycoplasma pharyngitis and shed light on the fatal complications of this infection if left untreated.