Lemierre syndrome: a diagnostic dilemma in paediatric patients

Lemierre's syndrome is a rare disease of the head and neck, characterized by an initial infection, usually within the oropharynx, which can develop into a septic thrombophlebitis. It can involve the jugular vein, facial veins and respiratory tract. A 7-year-old child attended our institution with a 1-week history of fever and cough. Initial imaging demonstrated a large left sided empyema with multiple cavitating lung lesions and persisting pneumothoraces secondary to the development of a bronchopleural fistula. There was no clinical improvement, despite an initial course of antibiotics. A contrast enhanced computed tomography (CT) of the head and neck revealed left mastoiditis, multiple cerebral abscesses and thrombus within the left internal jugular vein. Antibiotic therapy was modified. The empyema was surgically drained and bronchopleural fistula repaired. This case illustrates an atypical presentation of Lemierre's syndrome in a child, with respiratory complications secondary to septic emboli.