Pediatric Lemierre's syndrome: A systematic review

Lemierre syndrome (LS) is a condition characterized by septic thrombophlebitis of the internal jugular vein. Prompt diagnosis and appropriate management are crucial to achieve a good prognosis. Controversy remains regarding the management of this condition in children. The aim of this study is to provide physicians with an update regarding the clinical presentation, management, and prognosis of LS in children.

This systematic review was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Search performed using PubMed and Google Scholar databases targeting pediatric patients (<18 years old) with LS and included the following terms: Lemierre's Syndrome, thrombophlebitis, Internal jugular vein thrombosis, pediatric, and F.necrophorum.

423 studies were identified, and 53 studies reporting 143 individual cases that met the diagnostic criteria of LS were included; the mean age was 15.2 years (SD ± 3.6). Fever was the most common presenting symptom in 92% of patients, and F. necrophorum was the predominantly identified organism in 78.3% of patients. Computed tomography (CT) imaging was utilized in 89.5% of cases, and was most useful for detecting thrombosis of the internal jugular vein and septic emboli. Antibiotics were administered to all patients. Anticoagulation therapy was used in 62.2% of cases. 6% of patients required surgical intervention. Long-term complications were reported in 4.2% of patients. The mortality rate was 1.4%.

Early diagnosis and medical management in suspected cases of LS appear to prevent complications resulting from this syndrome. Interdisciplinary collaboration will be essential to achieve this and improve patient outcomes.