Lemierre syndrome: a pediatric case series and review of literature

Ridgway, James M.; Parikh, Dhavan A.; Wright, Ryan; Holden, Paul; Armstrong, William; Camilon, Felizardo; Wong, Brian J.-F.

doi:10.1016/j.amjoto.2008.09.006

« Previous Next »American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume 31, Issue 1 , Pages 38-45, January 2010

Lemierre syndrome: a pediatric case series and review of literature

James M. Ridgway, MD
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
- Corresponding author. Department of Otolaryngology-Head and Neck Surgery, University of Washington, Box 356515, Seattle, WA 98195, USA. Tel.: +1 206 386 3550.
Dhavan A. Parikh, MA
- University of California, Irvine, School of Medicine, Irvine, CA, USA
Ryan Wright, BS
- University of California, Irvine, School of Medicine, Irvine, CA, USA
Paul Holden, PhD
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA, USA
William Armstrong, MD
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA, USA
Felizardo Camilon, MD
- Children's Hospital of Orange County, Orange, CA, USA
Brian J.-F. Wong, MD, PhD
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA, USA

Received 31 August 2008 published online 27 March 2009.

Abstract

Background

Lemierre syndrome is a rare disease of the head and neck often affecting adolescents and young adults. Classically, infection begins in the oropharynx with thrombosis of the tonsillar veins followed by involvement of the parapharyngeal space and the internal jugular vein. Septicemia and pulmonary lesions develop as infection spreads via septic emboli. Although a rare entity in modern times, Lemierre syndrome remains a disease of considerable morbidity and potential mortality.

Methods

This was a retrospective review of 3 cases and associated literature.

Results

A common 1- to 2-week history of fever, sore throat, neck pain, and fatigue was observed in all patients. Patient 1 developed right facial swelling, neck tenderness, trismus, and tonsillar exudate. Patient 2 displayed right tonsillar erythema and enlargement with right neck tenderness. Patient 3 revealed bilateral tonsillar enlargement with exudate and left neck tenderness. Subsequent studies included blood cultures and computed tomography, after which empiric antibiotic therapy was started. Patient 1 underwent drainage of a right peritonsillar abscess, right pressure equalization tube placement, and ligation of the right external jugular vein. He subsequently developed subdural empyemas, cavernous sinus thrombosis, and carotid artery narrowing and required 9 weeks of antibiotic therapy. Patients 2 and 3 developed pulmonary lesions and received 6 weeks of antibiotic therapy. Timing was crucial in all cases.

Conclusions

Lemierre syndrome is a rare but severe opportunistic infection with poor prognostic outcomes if left untreated. Early diagnosis and treatment is essential. Aggressive antibiotic therapy coupled with surgical intervention, when necessary, provides excellent outcomes.