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Lemierre-like syndrome caused by community-associated methicillin-resistant Staphylococcus aureus complicated by hemorrhagic pericarditis

Hoehn, K. Sarah MD, MBe; Capouya, Jared D. MD; Daum, Robert S. MD; Glikman, Daniel MD; Gossett, Jeffrey G. MD; Hafzalah, Mina MD; Johnson, Daniel MD; Marcinak, John MD

Pediatric Critical Care Medicine: May 2010 - Volume 11 - Issue 3 - p e32-e35
doi: 10.1097/PCC.0b013e3181b806cb
Online Case Reports

Objective: To describe an infant with Lemierre-like syndrome caused by community-associated methicillin-resistant Staphylococcus aureus whose course was complicated by hemorrhagic pericarditis.

Design: Case report.

Setting: A 30-bed, pediatric intensive care unit at a tertiary care children’s hospital.

Patient: A 7-month-old infant presented with fever and torticollis attributable to a retropharyngeal abscess and left internal jugular venous thrombosis. He was treated with antibiotics and anticoagulation, and his course was complicated by hemorrhagic pericarditis and cardiac tamponade.

Interventions: Resuscitation of shock; video-assisted thoracoscopic drainage of bilateral empyema with pleural decortication; vancomycin and clindamycin treatment of methicillin-resistant Staphylococcus aureus; incision and drainage of retropharyngeal abscess; treatment of internal jugular venous thrombus with anticoagulation; and treatment of pericardial tamponade by insertion of pericardial drain.

Measurements and Main Results: Methicillin-resistant Staphylococcus aureus from blood and pleural fluid peel cultures were multi-locus sequence type 8, Panton-Valentine leukocidin-positive, and contained SCCmec IV, findings consistent with USA300 pulsotype. There was complete recovery from this life-threatening infection.

Conclusions: Septic jugular venous thrombophlebitis complicating upper airway infections is a rare but serious acute medical condition. We present an infant with methicillin-resistant Staphylococcus aureus infection and clinical features that overlapped those described by Lemierre, in whom hemorrhagic pericarditis developed while receiving anticoagulation therapy. Anticoagulation, if used, should be closely monitored in this population.

From Section of Pediatric Critical Care Medicine (KSH, MH), Department of Pediatrics, University of Chicago, IL; Infectious Diseases Section (JDC, RSD, DG, DJ, JM), Department of Pediatrics, the University of Chicago, IL; Section of Pediatric Cardiology (JGG), Department of Pediatrics, Children’s Memorial Hospital, Chicago, IL; Section of Advanced Pediatric Health Care Services (DJ), University of Chicago, Chicago, IL; Department of Pediatrics (KSH), the University of Chicago, IL; Inpatient Pediatric Services (JDC), Mary Bridge Children’s Hospital, Tacoma, WA; Infectious Diseases Unit (DG), Western Galilee Hospital, Nahariya, Israel.

The authors have not disclosed any potential conflicts of interest.

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©2010The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies