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Lemierre syndrome and unexpected death in childhood
John D Gilbert1, Morgyn S Warner, Roger W Byard
1Forensic Science SA, Adelaide, Australia.
Abstract:
Lemierre syndrome refers to necrotizing infections of the head due to Fusobacterium necrophorum and has been called the 'forgotten disease' due to its rarity in the antibiotic era. Recently, however, more cases have been documented in the literature suggesting that there has been an increase in incidence. A 10-year-old boy is reported who had a five-day history of ear infection, with the development of fever, drowsiness and ipsilateral neck swelling. Unexpected cardiac arrest occurred soon after medical assessment. At autopsy, right otitis media was demonstrated with extension of suppurative infection into subcutaneous tissues behind the ear and also into the extradural space at the lateral end of the petrous temporal bone. There was also septic thrombophlebitis of the adjacent sigmoid sinus, but no evidence of meningitis. This case demonstrates yet another infectious condition that may be associated with rapid deterioration and unexpected death in childhood. An autopsy approach to suspected sepsis in childhood is outlined.
Insights
Lemierre syndrome, a rare necrotizing head infection, is re-emerging. This case highlights rapid deterioration and death in a child due to Fusobacterium necrophorum.
Area of Science:
- Infectious Diseases
- Pediatric Pathology
- Microbiology
Background:
- Lemierre syndrome, caused by Fusobacterium necrophorum, is a rare but severe infection historically termed the 'forgotten disease'.
- Recent literature suggests an increasing incidence of Lemierre syndrome, challenging its 'forgotten' status.
- The syndrome typically involves necrotizing infections of the head and neck.
Observation:
- A case report details a 10-year-old boy with a five-day history of ear infection.
- Symptoms included fever, drowsiness, and ipsilateral neck swelling, rapidly progressing to cardiac arrest.
- Autopsy revealed right otitis media with contiguous spread of infection.
Findings:
- Infection extended into subcutaneous tissues, the extradural space, and involved septic thrombophlebitis of the sigmoid sinus.
- No evidence of meningitis was found.
- The autopsy confirmed necrotizing infection originating from otitis media.
Implications:
- This case underscores the potential for rapid, fatal deterioration in children with seemingly common infections.
- It highlights the importance of recognizing and managing Lemierre syndrome, even in the antibiotic era.
- An autopsy-guided approach to suspected childhood sepsis is presented as a critical diagnostic tool.
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