Lemierre-like syndrome caused by community-associated methicillin-resistant Staphylococcus aureus complicated by hemorrhagic pericarditis.
OBJECTIVE
To describe an infant with Lemierre-like syndrome caused by community-associated methicillin-resistant Staphylococcus aureus whose course was complicated by hemorrhagic pericarditis.


METHODS
Case report.


METHODS
A 30-bed, pediatric intensive care unit at a tertiary care children's hospital.


METHODS
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Hoehn
K Sarah
KS
Section of Pediatric Critical Care Medicine, Department of Pediatrics, University of Chicago, IL, USA. sarah1220@comcast.net
Capouya
Jared D
JD
Daum
Robert S
RS
Glikman
Daniel
D
Gossett
Jeffrey G
JG
Hafzalah
Mina
M
Johnson
Daniel
D
Marcinak
John
J
D006474:Hemorrhagic Disorders / Q000150:complications*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007601:Jugular Veins; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D010493:Pericarditis / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D017703:Retropharyngeal Abscess; D013203:Staphylococcal Infections / Q000150:complications* / Q000188:drug therapy; D013577:Syndrome; D013924:Thrombophlebitis / Q000209:etiology* / Q000503:physiopathology; D014103:Torticollis / Q000209:etiology / Q000503:physiopathology