Pediatric Patient with Lemierre Syndrome of the External Jugular Vein: Case Report and Literature Review

Schwarz, Yehuda; Habashi, Nadeem; Rosenfeld-Yehoshua, Noa; Soikher, Eugene; Marom, Tal; Tamir, Sharon Ovnat

doi:10.1055/s-0040-1721337

Cited by 5 publications

(4 citation statements)

References 29 publications

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“…Due to the rarity of this syndrome in the pediatric population, there are very few reports of atypical presentations. The most common thrombosis locations are the external jugular vein and sigmoid, cavernous, and transverse sinuses (19,20). To this date, no reports of LS presenting with isolated thrombophlebitis of the facial vein have been described in pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

Lemierre’s Syndrome with Facial Vein Thrombosis and Pulmonary Septic Emboli: A Case Report

Maia

Catarino²,

Freitas

et al. 2022

Arch Pediatr Infect Dis

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Introduction: Lemierre’s syndrome (LS) is a rare and serious condition that often affects school-aged children, adolescents, and healthy young adults. It is defined as an oropharyngeal infection with secondary septicemia, internal jugular vein thrombosis, and septic emboli. Rare cases of atypical LS in which thrombosis occurs in other locations have been reported. Case Presentation: We presented a case of an adolescent with fever, sore throat, and neck tenderness. Physical examination revealed acute pharyngitis and bilateral small cervical lymph nodes. Rapid antigen group A Streptococcus and viral serologic tests were negative. Complete hemogram and blood biochemical analysis showed leukocytosis and elevated serum C-reactive protein (CRP). Cervical computerized tomography (CT) scan revealed a heterogeneous right tonsil and small cervical lymph nodes. The chest radiograph was normal. After admission, the adolescent started complaining of dyspnea and thoracic pain and had a painful small cervical right mass. In the thoracic CT angiography (CTA), several pulmonary septic emboli were apparent throughout the pulmonary parenchyma. Cervical Doppler ultrasound showed right facial vein thrombophlebitis, later confirmed in a CTA. Thromboses in other locations, including the internal jugular vein, were excluded, as well as cervical abscesses. The patient was successfully treated with intravenous antibiotic therapy and anticoagulation. Discussion: To this date, no reports of LS presenting with isolated thrombosis of the facial vein have been described in pediatric patients. We highlighted the importance of early recognition of LS and its atypical variants. Pediatric international guidelines regarding its management and treatment would also greatly affect the outcome of these patients.

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Section: Discussionmentioning

confidence: 99%

Lemierre’s Syndrome with Facial Vein Thrombosis and Pulmonary Septic Emboli: A Case Report

Maia

Catarino²,

Freitas

et al. 2022

Arch Pediatr Infect Dis

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“…Notably, a study conducted by Schwartz et al focusing on infections involving the EJV identi ed 21 relevant studies (n = 16 cases). 4 In contrast, our literature review diverges from their speci c focus and encompasses patients with isolated EJV thrombophlebitis attributed to various etiologies. After reviewing the abstracts and references, a total of 33 articles comprising solely case reports or case series were identi ed (Table 3).…”

Section: Review Of the Literaturementioning

confidence: 99%

“…Some studies have suggested that anatomical variations in the jugular venous system might contribute to this observation. 4,36,37 During our investigation into the underlying cause of thrombosis in our patient, the care team deliberated on the potential presence of Lemierre's syndrome. However, the absence of typical symptoms and sequelae, such as pulmonary septic emboli, the identi cation of GAS as the cultured organism, and the isolated involvement of the EJV, made the diagnosis less likely at that time.…”

Section: Review Of the Literaturementioning

confidence: 99%

“…41 Several cases of EJV thrombosis cited in this study did use anticoagulation. 4,6,9,11,[13][14][15][16]18,[20][21][22][23]25,27,[29][30][31]33,34,41 However, the use of anticoagulants remains controversial due to potential risks such as hemorrhage, thrombocytopenia, and skin necrosis. These risks must be carefully weighed against the potential of a fatal thromboembolic event.…”

Section: Review Of the Literaturementioning

confidence: 99%

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Isolated External Jugular Thrombophlebitis Secondary to Acute Pharyngitis: A Case Report and a Review of the Literature

Ezeh,

Tesema,

Hasnie

et al. 2024

Preprint

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Background External Jugular Thrombophlebitis (EJT) is a rare clinical phenomenon with few reports in the literature, especially in the pediatric population. This is a report of an unusual case of right-sided EJT in a pediatric patient secondary to acute pharyngitis with sinusitis most prominent on the left side. Case presentation: A 13-year-old presented to the emergency department with worsening upper respiratory infectious (URI) symptoms and facial swelling, cough, throat pain, and emesis. The patient had traveled to Switzerland and received amoxicillin for strep throat 6 weeks before this hospitalization. Physical examination revealed nasal purulence, allodynia over the right side of the face without overlying erythema, and oropharyngeal exudate. CT scan revealed left-sided predominate sinusitis and right external jugular vein thrombosis. Blood cultures confirmed the presence of group A streptococcus infection. Treatment included IV antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), IV steroids, and anticoagulation. Follow-up imaging demonstrated improvement in thrombosis, cellulitis, and sinus disease. The patient was discharged on antibiotics for 6 weeks and anticoagulation for 10 weeks. Follow-up imaging at 6 months revealed no EJT, and medications were discontinued. Conclusions EJT is a rare condition, and to our knowledge, no reports of EJT with sinusitis most pronounced on the contralateral side have been published. Physicians will benefit from noting clinical signs of EJT such as facial edema, headache, erythema, and palpable neck mass, especially if these symptoms occur with URI symptoms refractory to treatment. The use of anticoagulation is controversial for internal jugular vein thrombosis, and while no guidelines for EJT exist, anticoagulation is likely not necessary save for severe complications.

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Lemierre’s syndrome complicating deep neck abscess: a case report

Xu,

Shi,

Ying

2023

Thrombosis J

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Background Lemierre’s Syndrome is a severe medical condition that can result from oropharyngeal infection, typically caused by Fusobacterium necrophorum, leading to sepsis, internal jugular vein thrombosis, and metastatic septic emboli. However, there is limited literature on this syndrome caused by Streptococcus anginosus, and few previous cases have been reported to have deep neck space infection. We present the first case of Lemierre’s Syndrome caused by Streptococcus anginosus with deep neck abscess. Case presentation A 53-year-old male patient with no significant medical history presented with right neck pain after accidentally swallowing a fish bone one month ago. Laryngoscopy did not reveal any abnormalities. Five days prior to admission, the patient developed high fever. Imaging studies showed internal jugular vein thrombosis and a neck abscess surrounding the carotid artery sheath. Blood culture results were positive for Streptococcus anginosus infection, and the patient was diagnosed with Lemierre’s syndrome. The patient underwent surgical drainage and received antibiotics and anticoagulant therapy, and had satisfactory clinical progress. He was discharged after a 16-day hospitalization. Conclusions Although Lemierre’s syndrome is rare, it needs attention because it can lead to serious complications and requires timely treatment. Deep neck space infections can be life-threatening and doctors must be aware of its potential severity.

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Pediatric Patient with Lemierre Syndrome of the External Jugular Vein: Case Report and Literature Review

Cited by 5 publications

References 29 publications

Lemierre’s Syndrome with Facial Vein Thrombosis and Pulmonary Septic Emboli: A Case Report

Lemierre’s Syndrome with Facial Vein Thrombosis and Pulmonary Septic Emboli: A Case Report

Isolated External Jugular Thrombophlebitis Secondary to Acute Pharyngitis: A Case Report and a Review of the Literature

Lemierre’s syndrome complicating deep neck abscess: a case report

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