881 A Rare Case of Lemierre Syndrome in a 13 Year Old Child

Abstract

Object To present a rare case of Lemierre syndrome in a 13 year old girl. Case Report The child presented with pyrexia, pharyngitis and dysphagia of 9 days duration. On the fifth day of pyrexia she developed a painful mass on the left side of her neck with bilateral tonsillar enlargement with exudate. The patient underwent cervical ultrasound and magnetic resonance angiography of the brain that revealed septic thrombophlebitis of the left internal jugular vein. Antibody testing for cytomegalovirus, Toxoplasma gondii and Bartonella henselae were negative for active infection. Blood cultures did not have any growth. Computed tomography of the chest revealed multiple bilateral septic emboli, although the patient did not have any overt respiratory symptoms. The patient received intravenous ceftriaxone and clindamycin for 3 weeks, followed by amoxicillin-clavoulanic acid orally for another 3 weeks along with anticoagulation therapy for 3 months in total. Three months later, she was clinically asymptomatic, computed tomography of the chest was clear and the thrombophlebitis of the left internal jugular vein was stable. Almost two years later, the patient remains in a very good clinical condition without any similar recurrences. Conclusions Lemierre syndrome is a rare combination of tonsillitis and septic thrombophlebitis of the internal jugular vein caused primarily by Fusobacterium necrophorum, an obligate anaerobic gram-negative rod. In our case, we did not isolate the causative agent, however the patient had an excellent outcome with antibiotic and anticoagulation therapy without any surgical intervention.