[Lemierre syndrome and influenza A (H1N1)]

Area of Science:

• Infectious Diseases
• Pediatrics
• Critical Care Medicine

Background:

• Lemierre syndrome, characterized by anaerobic bacteremia and internal jugular vein septic thrombophlebitis, is a rare but potentially life-threatening condition.
• It typically follows pharyngitis and can lead to septic emboli in various organs.
• While uncommon, recognizing and rapidly treating Lemierre syndrome is crucial for patient survival.

Observation:

• A 4-year-old child presented with fever, headache, and torticollis, testing positive for influenza A (H1N1) and beta-hemolytic streptococcal pharyngitis.
• Clinical worsening prompted a CT scan, revealing a parapharyngeal abscess and left internal jugular vein septic thrombophlebitis.
• Despite negative blood cultures, the clinical presentation strongly suggested Lemierre syndrome.

Findings:

• The patient received intravenous antibiotics (metronidazole and penicillin) and anticoagulation therapy.
• Septic thrombophlebitis resolved over a 2-month anticoagulation course, indicating successful treatment.
• This case highlights a potential link between influenza A (H1N1) infection and the development of Lemierre syndrome.

Implications:

• Influenza A (H1N1) virus may contribute to Lemierre syndrome by inducing transient immunosuppression, increasing susceptibility to secondary bacterial infections.
• This case underscores the importance of considering Lemierre syndrome in pediatric patients with severe pharyngitis and neurological symptoms, especially during viral outbreaks.
• Early diagnosis and aggressive management, including antibiotics and anticoagulation, are vital for favorable outcomes in Lemierre syndrome.