Severe atypical Lemierre syndrome caused by methicillin-sensitive Staphylococcus aureus: Two pediatric case reports

R El Hajj; A Stanzelova; C de Marcellus; M Kossorotoff; F Remangeon; C-J Roux; R Touzé; J Toubiana; S Benaboud; M Oualha; F Moulin; C Collignon

doi:10.1016/j.arcped.2023.02.007

Severe atypical Lemierre syndrome caused by methicillin-sensitive Staphylococcus aureus: Two pediatric case reports

Arch Pediatr. 2023 Jul;30(5):343-346. doi: 10.1016/j.arcped.2023.02.007. Epub 2023 Mar 27.

Authors

R El Hajj¹, A Stanzelova², C de Marcellus³, M Kossorotoff⁴, F Remangeon⁵, C-J Roux⁶, R Touzé⁷, J Toubiana², S Benaboud⁸, M Oualha⁹, F Moulin³, C Collignon¹⁰

Affiliations

¹ Pediatrics, André Mignot Hospital, Versailles, France.
² Department of General Pediatrics and Pediatric Infectious Diseases, Necker-Enfants Malades University Hospital, Paris, France; Université de Paris Cité, Paris, France.
³ Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France.
⁴ Pediatric Neurology, APHP University Hospital Necker-Enfants Malades, Paris, France.
⁵ Université de Paris Cité, Paris, France; Pediatric Otorhinolaryngology Department, APHP, Hôpital Universitaire Necker-Enfants Malades, Paris, France.
⁶ Pediatric Radiology, APHP University Hospital Necker-Enfants Malades, Paris, France.
⁷ Ophthalmology Department and Reference Center for Rare Ophthalmological Diseases (OPHTARA), AP-HP, University Hospital Necker-Enfants Malades, Paris, France; Université de Paris Cité, Paris, France.
⁸ Pharmacology Department, Cochin Hospital, AP-HP Centre-Université de Paris, Paris, France.
⁹ Université de Paris Cité, Paris, France; Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France.
¹⁰ Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France. Electronic address: [email protected].

PMID: 36990936
DOI: 10.1016/j.arcped.2023.02.007

Abstract

Background: Lemierre syndrome is typically associated with ear, nose, and throat (ENT) infections caused by Fusobacterium necrophorum. Since 2002, cases of atypical Lemierre-like syndrome secondary to Staphylococcus aureus have been reported.

Cases: We report two pediatric cases of atypical Lemierre syndrome with a similar presentation: exophthalmia, absence of pharyngitis, metastatic lung infection, and intracranial venous sinus thrombosis. Both patients had a favorable outcome following treatment with antibiotics, anticoagulation, and corticosteroids.

Conclusion: Regular therapeutic monitoring of antibiotic levels helped to optimize antimicrobial treatment in both cases.

Keywords: Lemierre syndrome; Pediatric intensive care; Staphylococcus aureus; Therapeutic drug monitoring.

Publication types

Case Reports

MeSH terms

Anti-Bacterial Agents / therapeutic use
Child
Humans
Lemierre Syndrome* / complications
Lemierre Syndrome* / diagnosis
Lemierre Syndrome* / drug therapy
Methicillin / therapeutic use
Pharyngitis* / etiology
Staphylococcal Infections* / complications
Staphylococcal Infections* / diagnosis
Staphylococcal Infections* / drug therapy
Staphylococcus aureus

Substances

Methicillin
Anti-Bacterial Agents