Published online April 15, 2005
PEDIATRICS Vol. 115 No. 5 May 2005, pp. e620-e622 (doi:10.1542/peds.2004-2505)
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ELECTRONIC ARTICLE

Respiratory Failure and Hypercoagulability in a Toddler With Lemierre's Syndrome

Tal Schmid, MD*, Hagit Miskin, MD{ddagger}, Yechiel Schlesinger, MD§, Zvi Argaman, MD* and David Kleid, MD*

* Pediatric Intensive Care Unit
{ddagger} Pediatric Hematology Unit
§ Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel

A 3.5-year-old healthy boy with 4 days of fever was referred to the emergency department for respiratory distress. The physical examination was remarkable for stupor, tachycardia, tachypnea, and dyspnea. Initial blood tests showed pancytopenia. He rapidly developed torticollis. Computerized tomography of the neck revealed a thrombus in the internal jugular vein. A presumptive diagnosis of Lemierre's syndrome was made and he was started on antibiotics and anticoagulation. He subsequently developed adult respiratory distress syndrome and required high frequency oscillatory ventilation for 9 days. Blood cultures were positive for Fusobacterium necrophorum. Screening for hypercoagulability revealed 2 known risk factors: a mutation in the prothrombin gene and elevated lipoprotein a.

Key Words: Lemierre's syndrome • respiratory insufficiency • thrombophilia • toddlers • torticollis

Abbreviations: LS, Lemierre's syndrome • ED, emergency department • bpm, beats per minute • CSF, cerebrospinal fluid • WBC, white blood cell • CT, computed tomography • FIO2, fraction of inspired oxygen

Accepted Nov 29, 2004.


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