title: Lemierre syndrome: a pediatric case series and review of literature.
abstract: BACKGROUND
  Lemierre syndrome is a rare disease of the head and neck often affecting adolescents and young adults. Classically, 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. Although a rare entity in modern times, Lemierre syndrome remains a disease of considerable morbidity and potential mortality.
  
  
  METHODS
  This was a retrospective review of 3 cases and associated literature.
  
  
  RESULTS
  A common 1- to 2-week history of fever, sore throat, neck pain, and fatigue was observed in all patients. Patient 1 developed right facial swelling, neck tenderness, trismus, and tonsillar exudate. Patient 2 displayed right tonsillar erythema and enlargement with right neck tenderness. Patient 3 revealed bilateral tonsillar enlargement with exudate and left neck tenderness. Subsequent studies included blood cultures and computed tomography, after which empiric antibiotic therapy was started. Patient 1 underwent drainage of a right peritonsillar abscess, right pressure equalization tube placement, and ligation of the right external jugular vein. He subsequently developed subdural empyemas, cavernous sinus thrombosis, and carotid artery narrowing and required 9 weeks of antibiotic therapy. Patients 2 and 3 developed pulmonary lesions and received 6 weeks of antibiotic therapy. Timing was crucial in all cases.
  
  
  CONCLUSIONS
  Lemierre syndrome is a rare but severe opportunistic infection with poor prognostic outcomes if left untreated. Early diagnosis and treatment is essential. Aggressive antibiotic therapy coupled with surgical intervention, when necessary, provides excellent outcomes.
authors: Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA 98195, USA. jridgway@u.washington.edu
authors: James M
authors: JM
authors: Ridgway
authors: Dhavan A
authors: DA
authors: Parikh
authors: Ryan
authors: R
authors: Wright
authors: Paul
authors: P
authors: Holden
authors: William
authors: W
authors: Armstrong
authors: Felizardo
authors: F
authors: Camilon
authors: Brian J-F
authors: BJ
authors: Wong
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D005674:Fusobacterium Infections / Q000175:diagnosis* / Q000628:therapy*; D005675:Fusobacterium necrophorum; D006801:Humans; D008297:Male; D018805:Sepsis / Q000175:diagnosis* / Q000628:therapy*; D013577:Syndrome; D013924:Thrombophlebitis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D014069:Tonsillitis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents