Lemierre syndrome: a pediatric case series and review of

literatureIntroduction by

Dr.Roohia Disscussion by

Dr. Ramanjaneyulu

James M. Ridgway, MD(a) Dhavan A. Parikh, Ma(b) Ryan Wright, BS(b),Paul Holden, PhD© William Armstrong, MD(c)Felizardo Camilon, MD(d)Brian J.-F. Wong , MD, PhD(c)

a)Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA b)University of California, Irvine, School of Medicine, Irvine, CA, USA c)Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA, USA d)Children's Hospital of Orange County, Orange, CA, USA

introductionLemierre syndrome is a rare disease of the

head and neck often affecting adolescents and young adults.

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.

a retrospective review of 3 cases and associated literature

LEMIERRE’S SYNDROME

( A Forgotten Disease)

ANDRE LEMIERRE(1936)

Epidemiology The incidence of Lemierre syndrome has

been reported between 0.6 and 2.3 per million.

Mortality rates between 4% and 18%. Young adults between the ages of 16 and 25

years.

Lemierre syndromeFusobacterium species

F nucleatum and F necrophorum

normal inhabitants of the oral cavity, the female genital tract, and the gastrointestinal tract

strictly anaerobic, non-motile, Gram-negative bacillus .

Multiple virulence factors including cell wall lipopolysaccharideendotoxin, leucocidin, hemolysin, lipase,

hemagglutinin, and a cytoplasmic toxin

are produced by F necrophorum

OTHERS: Streptococcus Bacteroides Lactobacillus Staphylococcus Eikinella

Primary source of infectionPalatine tonsils

and peritonsillar tissuePharyngitisParotitisOtitis mediaSinusitisOdontogenic

infectionMastoiditis

Pathophysiology

StagesPatient generally exhibits three stages

1. Pharyngitis – sore throat (< 1 week) 2. Local invasion of lateral pharyngeal space and IJV septic thrombophlebitis swollen/tender neck = red flag3. Metastatic complications – fever, pulmonary infiltrates or possible joint involvement

Disease PresentationSore throatTender/swollen lymph nodesProlonged feverMay experience abdominal pain, nausea or

vomittingBacteremiaIncreased WBC’s Hyperbilirubinemia and slight increase in liver

enzymes

FEATURES OF METASTATIC COMPLICATIONS Pulmonary involvement

Pleuritic chest pain, dry cough, hemoptysis, ARDS

Bone and joint manifestationsSeptic arthritis, osteomyelitis

Soft tissue lesionsGluteal & abdominal wall abscesses

Intra-abdominal sepsisAbdominal pain, Jaundice, liver & splenic abscess,

Peritonitis

FEATURES OF METASTATIC COMPLICATIONS CNS complications

Meningitis, cerebral abscess, cavernous sinus & sigmoid sinus thrombosis

Renal complicationsRenal abscess, glomerulonephritis, hemolytic-

uremic syndrome

Hematological complicationsDIC, peripheral ischemia & gangrene

DIFFERENTIAL DIAGNOSISViral PharyngitisInfectious MononucleosisPneumoniaTuberculosisEndocarditis