Lemierre Syndrome in a Pediatric Patient with Nephrotic Syndrome: a Case Report
Keywords:
Lemierre syndrome, pediatric emergency department, case reportAbstract
Lemierre syndrome is a rare thrombotic complication of head and neck infections. Nephrotic syndrome is sometimes treated by immunosuppressive medications that can present with severe infections without a fever. The association of the two diseases is extremely rare.
We report the first case, to our knowledge, of Lemierre syndrome in an eleven-year-old patient with nephrotic syndrome on Tacrolimus.
A patient with nephrotic syndrome is at higher risk for all kinds of thrombotic events. Also, being on immunosuppressive therapy can lead to late presentation and the absence of fever. A low level of suspicion in those patients can lead to timely diagnosis and early treatment.
References
Ramirez S, Hild TG, Rudolph CN, Sty JR, Kehl SC, Havens P, Henrickson K, Chusid MJ. Increased diagnosis of Lemierre syndrome and other Fusobacterium necrophorum infections at a Children's Hospital. Pediatrics. 2003 Nov;112(5):e380. doi: 10.1542/peds.112.5.e380. PMID: 14595080.
Lu MD, Vasavada Z, Tanner C. Lemierre syndrome following oropharyngeal infection: a case series. J Am Board Fam Med. 2009 Jan-Feb;22(1):79-83. doi: 10.3122/jabfm.2009.01.070247. PMID: 19124638.
Cho YP, Choi SJ, Jung BH, Hwang JW, Han MS, Kim YH, Kwon TW, Lee SG. Lemierre's syndrome in a patient with antiphospholipid syndrome. Ann Vasc Surg. 2006 Mar;20(2):274-7. doi: 10.1007/s10016-006-9004-4. Epub 2006 Mar 24. PMID: 16557426.
Kerlin BA, Ayoob R, Smoyer WE. Epidemiology and pathophysiology of nephrotic syndrome-associated thromboembolic disease. Clin J Am Soc Nephrol. 2012 Mar;7(3):513-20. doi: 10.2215/CJN.10131011. Epub 2012 Feb 16. PMID: 22344511; PMCID: PMC3302669.
Vyas V, Kapoor S, Panda M, Mandal Ravi RN. Thrombosis of internal jugular vein in nephrotic syndrome presenting as neck pain. Indian J Pediatr. 2012 Oct;79(10):1388. doi: 10.1007/s12098-012-0705-0. Epub 2012 Feb 22. PMID: 22354816.
Screaton NJ, Ravenel JG, Lehner PJ, Heitzman ER, Flower CD. Lemierre syndrome: forgotten but not extinct--report of four cases. Radiology. 1999 Nov;213(2):369-74. doi: 10.1148/radiology.213.2.r99nv09369. PMID: 10551214.
Fujii T, Iwabuchi Y, Moriyama T, Uchida K, Nitta K. A case of Lemierre syndrome combined with a suspected systemic lupus erythematosus flare. SAGE Open Med Case Rep. 2019 Aug 22;7:2050313X19871782. doi: 10.1177/2050313X19871782. PMID: 31489196; PMCID: PMC6709436.
Hagiya H, Haruki Y, Otsuka F. Lemierre syndrome involving external jugular vein. Acute Med Surg. 2014 Jul 10;2(1):64-68. doi: 10.1002/ams2.61. PMID: 29123694; PMCID: PMC5667194.
Tan ZL, Nagaraja TG, Chengappa MM. Fusobacterium necrophorum infections: virulence factors, pathogenic mechanism and control measures. Vet Res Commun. 1996;20(2):113-40. doi: 10.1007/BF00385634. PMID: 8711893.
Cristina L, Benilde C, Michela C, Mirella F, Giuliana G, Gualtiero P. High plasma levels of factor VIII and risk of recurrence of venous thromboembolism. Br J Haematol. 2004 Feb;124(4):504-10. doi: 10.1046/j.1365-2141.2003.04795.x. PMID: 14984502.
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