Neurological complications in two children with Lemierre syndrome
Basheer Peer Mohamed1, Lucinda Carr
1Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK. pmbasheer@doctors.net.uk
Insights
Lemierre syndrome, a serious infection, can cause severe neurological issues like cranial nerve palsies and spinal epidural abscesses. Early antibiotic and anticoagulant treatment is key for recovery from this rare but dangerous condition.
Area of Science:
- Infectious Diseases
- Neurology
- Otolaryngology
Background:
- Lemierre syndrome is characterized by oropharyngeal sepsis, internal jugular vein thrombosis, and septic metastases, historically associated with high mortality.
- While antibiotics reduced its incidence, a recent resurgence of Lemierre syndrome has been observed.
- Fusobacterium species are the primary causative agents of this distinct clinical entity.
Observation:
- Two adolescent cases of Lemierre syndrome are presented, highlighting significant neurological complications.
- One patient developed extensive leptomeningitis and cranial nerve palsies (6th and 12th) due to clival involvement, termed 'clival syndrome'.
- The other patient experienced 12th cranial nerve palsy secondary to clival osteomyelitis.
Findings:
- Both patients presented with neurological sequelae, including cranial nerve palsies and, in one case, a cervical epidural abscess.
- Conservative management involving extended antibiotic courses and anticoagulation for jugular vein thrombosis resulted in good recovery for both individuals.
- Prompt recognition and management of neurological complications are vital for improving patient outcomes.
Implications:
- This case series underscores the potential for severe neurological involvement in Lemierre syndrome, even with modern antibiotic use.
- The 'clival syndrome' and spinal epidural abscesses represent critical, potentially life-threatening complications.
- Increased awareness and timely, multidisciplinary management are essential to reduce morbidity and mortality associated with this 'forgotten disease'.
Abstract:
Lemierre syndrome is a distinct clinical syndrome comprising oropharyngeal sepsis and fever, internal jugular vein thrombosis and remote septic metastases caused by Fusobacterium species. The mortality rate was historically high and although use of antibiotics led to a dramatic fall in incidence, a resurgence has been seen recently. A 14-year-old male developed Lemierre syndrome after tonsillitis. There was extensive leptomeningitis, especially over the clivus, causing 6th and 12th cranial nerve palsies, a clinical feature termed the 'clival syndrome'. He also developed an epidural abscess in the cervical spine, which was unsafe for surgical drainage. Conservative treatment with an extended course of antibiotics and anticoagulation for jugular vein thrombosis led to a good recovery. A 15-year-old female developed Lemierre syndrome after a persistent sore throat lasting 7 weeks. She had palsy of the 12th cranial nerve from clival osteomyelitis. She was treated with a 6-week course of antibiotics and anticoagulants leading to almost full recovery at 3-month review. Awareness of the potential neurological complications of Lemierre syndrome and prompt management are crucial in reducing morbidity and mortality in this 'forgotten disease'.
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