# A Case of Lemierre-Like Syndrome in a Pediatric Patient

## TL;DR

This paper reports a rare case of Lemierre-like syndrome in a five-month-old infant caused by MRSA, highlighting the importance of early diagnosis and aggressive treatment.

## Contribution

The novelty lies in presenting a pediatric case of Lemierre-like syndrome caused by MRSA, emphasizing the severity and treatment challenges in infants.

## Key findings

- The patient developed acute respiratory failure due to MRSA-induced Lemierre-like syndrome.
- CT scans revealed deep neck infection, pleural empyema, and mediastinitis requiring surgical intervention.
- Prompt and aggressive treatment, including surgery and multiple antibiotics, was essential for recovery.

## Abstract

Lemierre-like syndrome is a rare, systemic sequelae following a persistent oropharyngeal infection, leading to septic thrombophlebitis of the internal jugular vein (IJV). Lemierre syndrome is caused by the obligate anaerobic organism Fusobacterium necrophorum, innate to the oropharyngeal tract. Lemierre-like syndrome is due to infections caused by other organisms, including methicillin-resistant Staphylococcus aureus (MRSA). We are reporting a case of a five-month-old male who presented with one week of fever that was not alleviated by acetaminophen, bilateral otitis media, and left-sided cervical lymphadenopathy not alleviated with medical therapy. The patient’s clinical course continued to deteriorate as he developed respiratory distress that progressed to acute respiratory failure requiring mechanical ventilation support. Extensive laboratory investigation ruled out the causes of primary and secondary immunodeficiencies. Blood cultures were positive for MRSA, and he was treated initially with vancomycin, then switched to linezolid per ENT recommendations, and ultimately needed daptomycin and ceftaroline therapy. A computed tomography (CT) scan of the neck and chest showed deep neck space infection, bilateral loculated pleural empyema, and mediastinitis. The patient required a decortication video-assisted thoracoscopic surgery (VATS), multiple drains, and a mediastinal washout to control the MRSA infection. This report emphasizes that the rapid progression and spread of septic thrombus can become detrimental to a patient’s recovery and survival; therefore, it should be recognized early and treated promptly.