Lemierre’s Syndrome: A Case Report of a Child With Partial Treatment of Streptococcal Pharyngitis

Abstract

Lemierre’s syndrome (LS) is a complication of acute oropharyngeal infections leading to septic thrombophlebitis of the internal jugular vein. Since initial discovery, the incidence of LS has decreased due to development of modern antibiotics. In our case report, a child with partially treated streptococcal pharyngitis presented with neck pain, neck swelling and limited range of motion of her neck. Although the patient was well appearing and with an atypical presentation of LS, the diagnosis of LS was confirmed with a computed tomography (CT). As a result, appropriate treatment was quickly initiated to prevent further complication and provide a favorable outcome for the patient. Typical presenting symptoms of LS include fever, dysphagia, neck pain and arthralgia that should lead to the ordering of appropriate laboratory studies and imaging. CT imaging aids in both the diagnosis and management of LS. The use of anticoagulation therapy remains controversial in the management of LS. In addition, there are no generalized guidelines for the treatment of LS, but antibiotic therapy directed at anaerobic coverage can significantly reduce morbidity and mortality in otherwise healthy children. Due to potentially fatal complications, it is crucial to keep LS on the differential diagnosis list in pediatric patients with fever, neck pain, neck swelling, or dysphagia in the week following an oropharyngeal infection. Int J Clin Pediatr. 2020;9(1):4-8 doi: https://doi.org/10.14740/ijcp347