Lemierre's syndrome: an unusual cause of sepsis and abdominal pain.

OBJECTIVE

To describe a patient with Lemierre's syndrome who presented with acute abdominal findings and to describe the evaluation and treatment of this syndrome.

DESIGN

Case report.

SETTING

A 38-bed, pediatric intensive care unit at a tertiary care children's hospital.

PATIENT

One patient presenting with signs of severe sepsis and acute abdominal pain.

INTERVENTIONS

Intravenous hydration, inotropic support, thoracostomy tube drainage of a pleural effusion, and prolonged antimicrobial therapy.

MEASUREMENT AND MAIN RESULTS

The patient presented with severe sepsis and abdominal pain. After Fusobacterium necrophorum grew in blood cultures, anaerobic antimicrobial therapy was initiated. Doppler duplex ultrasonography and magnetic resonance venography demonstrated thrombus formation in the left internal jugular vein. Computed tomography of the chest demonstrated bibasilar lung nodules consistent with septic emboli. The patient was treated with ampicillin-sulbactam and metronidazole intravenously for 3 wks, followed by a 3-wk course of oral amoxicillin/clavulanate. He had a good recovery, and his thrombus had resolved at the time of discharge.

CONCLUSION

Lemierre's syndrome occurs in young, otherwise healthy patients, and it thus needs to remain high on the differential diagnosis for this group of patients presenting with severe sepsis. The diagnosis can be confounded by a lack of symptoms of pharyngitis at the time of presentation and end-organ dysfunction associated with severe sepsis, suggesting alternative sources of infection.