Section of Pediatric Critical Care Medicine, Department of Pediatrics, University of Chicago, IL, USA.
Pediatr Crit Care Med. 2010 May;11(3):e32-5. doi: 10.1097/PCC.0b013e3181b806cb.
To describe an infant with Lemierre-like syndrome caused by community-associated methicillin-resistant Staphylococcus aureus whose course was complicated by hemorrhagic pericarditis.
Case report.
A 30-bed, pediatric intensive care unit at a tertiary care children's hospital.
A 7-month-old infant presented with fever and torticollis attributable to a retropharyngeal abscess and left internal jugular venous thrombosis. He was treated with antibiotics and anticoagulation, and his course was complicated by hemorrhagic pericarditis and cardiac tamponade.
Resuscitation of shock; video-assisted thoracoscopic drainage of bilateral empyema with pleural decortication; vancomycin and clindamycin treatment of methicillin-resistant Staphylococcus aureus; incision and drainage of retropharyngeal abscess; treatment of internal jugular venous thrombus with anticoagulation; and treatment of pericardial tamponade by insertion of pericardial drain.
Methicillin-resistant Staphylococcus aureus from blood and pleural fluid peel cultures were multi-locus sequence type 8, Panton-Valentine leukocidin-positive, and contained SCCmec IV, findings consistent with USA300 pulsotype. There was complete recovery from this life-threatening infection.
Septic jugular venous thrombophlebitis complicating upper airway infections is a rare but serious acute medical condition. We present an infant with methicillin-resistant Staphylococcus aureus infection and clinical features that overlapped those described by Lemierre, in whom hemorrhagic pericarditis developed while receiving anticoagulation therapy. Anticoagulation, if used, should be closely monitored in this population.
描述一例由社区相关性耐甲氧西林金黄色葡萄球菌引起的类勒米尔综合征婴儿，其病程并发出血性心包炎。
病例报告。
一家三级儿童医院的 30 张床位儿科重症监护病房。
一名 7 个月大的婴儿因咽后脓肿和左侧颈内静脉血栓形成出现发热和斜颈，经抗生素和抗凝治疗后，其病程并发出血性心包炎和心脏压塞。
休克复苏；胸腔镜辅助双侧脓胸引流并胸膜剥脱术；万古霉素和克林霉素治疗耐甲氧西林金黄色葡萄球菌；咽后脓肿切开引流；抗凝治疗颈内静脉血栓；心包穿刺引流治疗心包填塞。
血液和胸腔液剥脱培养的耐甲氧西林金黄色葡萄球菌多位点序列型 8、Panton-Valentine 白细胞毒素阳性，且含有 SCCmec IV，与 USA300 脉冲型一致。该婴儿从危及生命的感染中完全康复。
上呼吸道感染并发化脓性颈静脉血栓性静脉炎是一种罕见但严重的急性疾病。我们报告一例耐甲氧西林金黄色葡萄球菌感染的婴儿，其临床表现与 Lemierre 描述的重叠，在接受抗凝治疗期间发生出血性心包炎。在此人群中，如果使用抗凝剂，应密切监测。
