No abstract

Lemierre syndrome is extremely rare and poorly known to medical practitioners. In  childhood, this is completely casuistry, described almost exclusively in adolescents. The  key component of the syndrome is jugular vein thrombosis and sinus thrombosis, which develop against the background of polysinusitis and  purulent  otitis  and  are also  accompanied by  the  addition  of  pneumonia, meningitis  and  sepsis. Typically,  Lemierre’s syndrome is considered otogenic or sinusogenic sepsis. The nonspecificity of clinical manifestations against the background of the patient’s severe general condition determines the need for quick and accurate diagnosis, and ultrasound takes the first place in a series of radiation research methods, which allows differentiating jugular vein thrombosis. When the latter is found, MRI and CT are usually performed, in which  the presence of sinus thrombosis, inflammatory changes in the paranasal sinuses, pneumonia, etc. are usually confirmed. Further clinical and laboratory examination is designed to assess the presence of meningitis and a violation of the blood coagulation system. This publication provides 3 atypical observations of Lemierre’s syndrome in children: in the first case, it was thrombosis of the jugular vein that was first detected in an adolescent, and only then all other components of the syndrome; in the second case, the child was only 3 years old, which is completely atypical for this pathology, the third patient was 1 month old, and the diagnosis of Lemierre syndrome was made retrospectively. All children underwent a complex radiation examination, operated on, received massive syndrome therapy and were discharged home with recovery. The publication is extensively illustrated and contains a brief overview of the literature.

Takayasu’s arteritis is a chronic granulomatous arteritis with predominant involvement of the aorta and its main branches. It occurs both in youth and childhood, manifests between the ages of 10 and 30 years, female patients predominate. This article presents a clinical case of Takayasu’s arteritis in a child with prolonged fever. Clinical case. A 10-year-old girl E. was hospitalized with complaints of febrile fever episodes during the last two months; weakness and back pain were also noted.  Observed by an endocrinologist since 2015 with a diagnosis of Stunted growth. Delayed physical development. Diffuse changes of the thyroid gland, euthyroidism. Since 2020 has been observed with the diagnosis Constitutional immaturity. A tendency toward constipation was noted. Observed by an allergist with atopic dermatitis, food and respiratory allergies were diagnosed. By the time of hospitalization, the girl had been ill for two months. During this period, four episodes of fever with scanty catarrhal manifestations were recorded. The diagnostic search went in different directions, infectious, systemic and oncological diseases were excluded. The echographic pattern was typical and highly specific for Takayasu’s arteritis. Additional examination also revealed changes in the celiac trunk in the form of narrowing of its lumen. Clinical diagnosis «Non-specific aortoarteritis, type III, acute phase, stenotic variant, grade 1–3 activity with lesions of the right and left common carotid arteries and the celiac trunk» was made as a result of clinical, laboratory and instrumental examination. This clinical observation demonstrates the difficulty in making a diagnosis due to the variety of clinical forms and the absence of specific disease markers. It takes on average a year and a half from disease debut to clinical diagnosis of the patient. However, lack of therapy over a long period can be crucial for an adverse outcome of the disease.