A 10-month-old with Lemierre syndrome complicated by purulent pericarditis

Lemierre syndrome is a potentially life-threatening septic thrombophlebitis associated with a neck infection. We present a case of a 10-month-old female infant with Lemierre syndrome complicated by thrombotic strokes and purulent pericarditis. A healthy 10-month-old female infant presented to the pediatric emergency department of our tertiary care center complaining of 5 days of fever to 105°F and 1 day of neck stiffness and decreased oral intake. In the pediatric emergency department, she developed septic shock, requiring vasopressor support, endotracheal intubation, and broad-spectrum antibiotics. A computed tomographic scan demonstrated a neck abscess associated with a right internal jugular thrombus and septic emboli to her lungs and brain. This constellation was consistent with Lemierre syndrome. Further studies demonstrated the thrombus extended into her left ventricular outflow tract. She was emergently taken to the operating room for incision and drainage of her neck abscess, started on anticoagulation with heparin, and eventually transitioned to enoxaparin. Her hospital course was complicated by a middle cerebral artery distribution infarction and subsequent hemorrhagic conversion with generalized tonic clonic seizures managed by levetiracetam. Ten days into her hospital stay, she developed pericardial tamponade, and cardiac surgery performed a pericardial window for loculated, purulent pericardial effusion. Initial blood cultures were positive for methicillin-sensitive Staphylococcus aureus, and the patient was treated with 6 weeks of nafcillin. She has recovered with minimal permanent sequelae. This is one of the youngest cases of Lemierre syndrome documented. To our knowledge, it is also the first case complicated by purulent pericarditis reported in the literature.