A Lemierre's like syndrome in a 50 days old infant with Enterobacter cloaca bacteremia: A case report

Lemierre syndrome describes septic thrombophlebitis of the internal jugular vein (IJV) and metastatic spread of the infection following a recent oropharyngeal infection in a setting of bacteremia caused by Fusobacterium necrophorum. Lemierre-like syndrome describes similar clinical scenario with no preceding oropharyngeal infection and/or in the setting of non-Fusobacterium cause. We report a case of Lemierre-like syndrome in a setting of Enterobacter cloaca bacteremia without known preceding oropharyngeal infection. History and physical exam revealed an irritable infant with cough, tachypnea, low grade fever, bilateral lung crepitations and features of infantile seborrheic dermatitis on the scalp. Imaging revealed thrombosis of right internal jugular vein and superior vena cava, bilateral pulmonary cavitary lesions and collections consistent with septic pulmonary emboli. Multiple rim enhancing hypo-dense liver lesions and chest wall collections consistent with abscesses were also seen. He was managed with parental antibiotics, drainage of the chest wall abscesses and discharged with clinical and radiologic improvement.