Lemierre's syndrome resulting from streptococcal induced otitis media and mastoiditis: a case report

Abstract

IntroductionLemierre's syndrome is an extremely rare and almost universally fatal disease characterized as thrombophlebitis of the internal jugular venous system with subsequent metastatic infection. Fusobacterium necrophorum is the most common organism implicated in causation of Lemierre's syndrome. Group A Streptococcus has mainly been observed as a polymicrobial organism in the syndrome. We report a rare finding of a rare disease where Group A Streptococcus was the sole organism triggering Lemierre's syndrome. To our knowledge, this is only the third recorded patient with such an occurrence.Case presentationWe describe a 9-year-old African American boy, who presented with otitis media and mastoiditis that culminated in Lemierre's syndrome. Isolates bore only Group A Streptococcus. The patient was appropriately treated and responded with full recovery from the syndrome.ConclusionSince Lemierre's syndrome is classically detected by clinical diagnosis, these findings should prompt clinicians to consider Group A Streptococcus as an alternative catalyst. It should be pondered that patients who present with typical Group A streptococcal infections have the possibility for developing Lemierre's syndrome. Though this complication appears to be rare, early diagnosis and prompt intervention have proven critical in survival outcome. Indeed, what would seem to be a routine case of strep throat or otitis media easily treated with antibiotics could end up being an unalterable progression to death unless Lemierre's syndrome is immediately diagnosed and treated.

A Case of Lemierre Syndrome Secondary to Otitis Media and Mastoiditis

“…Though few in number, similar to the current case, IJV thrombophlebitis and sigmoid and transverse sinus thrombosis cases secondary to OM and mastoiditis have been reported in the literature [7]. …”

Beta-Haemolytic Group A, C and G Streptococcal Infections in Southern Hungary: A 10-Year Population-Based Retrospective Survey (2008–2017) and a Review of the Literature

“… 13 , 14 Nevertheless, they are also highly pathogenic, capable of causing a wide spectrum of illnesses, being an important factor of morbidity and mortality. 15 Mild manifestations may include tonsillo-pharyngitis (“strep throat”), wound infections and impetigo, 16 while severe infections, such as scarlet fever, 17 endophthalmitis, 18 mastoiditis, 19 septic arthritis, 20 osteomyelitis, 21 necrotizing fasciitis, 22 puerperal infections, 23 bacteremia and sepsis, 24 meningitis, 25 endocarditis, 26 and streptococcal toxic shock syndrome (STSS) 27 may also occur. In addition, clinicians must take into consideration the emergence of post-streptococcal manifestations, such as rheumatic fever, rheumatic heart disease, glomerulonephritis and other immune-mediated complications.…”

A Rare Case of Lemierre-Like Syndrome: A Case Report and Literature Review

“…In 2009, Harris et al reported a 9-year-old boy who developed LLS due to GAS that was isolated in a throat culture, but blood cultures were negative in that case [ 4 ]. Before that, in 2005 Wilson and Tierney [ 5 ] and in 2007 Anton [ 6 ] and Blumberg et al [ 7 ] had separately reported LLS that was solely caused by GAS bacteremia.…”