Kosoko Adeola Adekunbi, Clement Omoyeni O
University of Texas Health Sciences Center at Houston, Department of Emergency Medicine, Houston, Texas.
Clin Pract Cases Emerg Med. 2023 Aug;7(3):148-152. doi: 10.5811/cpcem.1580.
Lemierre syndrome (LS) is a rare condition with a high mortality risk. It is well described in older children and young adults involving bacteremia, thrombophlebitis, and metastatic abscess commonly due to Fusobacterium infections. Young, pre-verbal children are also susceptible to LS; thus, careful attention must be given to their pattern of symptoms and history to identify this condition in the emergency department (ED).
A 12-month-old previously healthy boy with a recent diagnosis of acute otitis media and viral illness presented to the ED with a complaint of fever. Additional symptoms developed at the head and neck and were noted on subsequent ED visits. Advanced imaging revealed significant lymphadenopathy and deep space inflammation extending to the mediastinum. Subsequent imaging confirmed extensive sinus and deep vein thromboses, consistent with LS. Methicillin-resistant Staphylococcus aureus (MRSA) was the only organism identified. After surgical debridement, appropriate intravenous antibiotics, and heparin anticoagulation therapy, the patient experienced full recovery after prolonged hospitalization.
A febrile infant with multiple acute care visits and development of lymphadenopathy, decreased oral intake, decreased cervical range of motion, and sepsis should raise suspicion for Lemierre syndrome. The medical evaluation of deep neck spaces and deep veins should be similar to that of older children and adults with LS, including advanced imaging of the head and neck. However, medical management should particularly target MRSA due to its emerging prevalence among infantile LS cases. Further research is necessary to determine the optimal management strategies of LS for this age group.
勒米尔综合征（LS）是一种罕见疾病，具有较高的死亡风险。在大龄儿童和青年中对其已有充分描述，通常由梭杆菌感染引起菌血症、血栓性静脉炎和转移性脓肿。年幼的学前期儿童也易患勒米尔综合征；因此，在急诊科（ED）必须仔细关注他们的症状模式和病史，以识别这种疾病。
一名12个月大、此前健康的男孩，近期诊断为急性中耳炎和病毒感染，因发热就诊于急诊科。随后在头部和颈部出现了其他症状，并在后续的急诊科就诊中被发现。高级影像学检查显示有明显的淋巴结病和延伸至纵隔的深部间隙炎症。后续影像学检查证实存在广泛的鼻窦和深静脉血栓形成，符合勒米尔综合征。耐甲氧西林金黄色葡萄球菌（MRSA）是唯一鉴定出的病原体。经过手术清创、适当的静脉抗生素治疗和肝素抗凝治疗后，患者在长期住院后完全康复。
一名发热婴儿多次接受急诊治疗，出现淋巴结病、口服摄入量减少、颈部活动范围减小和败血症，应怀疑为勒米尔综合征。对颈部深部间隙和深静脉的医学评估应与大龄儿童和成人勒米尔综合征患者相似，包括对头颈部进行高级影像学检查。然而，由于MRSA在婴儿勒米尔综合征病例中日益普遍，医疗管理应特别针对MRSA。有必要进行进一步研究以确定该年龄组勒米尔综合征的最佳管理策略。
