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Extensive thrombosis from cranial venous sinuses to superior vena cava in an infant with Lemierre syndrome with successful management

1UT Houston MD Anderson Cancer Center, Houston, Texas, United States, 2The University of Texas Health Science Center at Houston, McGovern Medical School, Gulf States Hemophilia and Thrombophilia Center, Houston, Texas, United States, 3UTHealth McGovern Medical School/Thrombosis Sub-Committee, Women and Girls with Blood Disorders - Learning Action Network, Houston, Texas, United States

Abstract Number: PB0261

Meeting: ISTH 2022 Congress

Theme: Pediatrics » Thrombosis in Neonates and Children

Background: Lemierre syndrome is rare disease entity characterized by infection of the oropharynx and septic thrombosis of the internal jugular vein, which can progress to septicemia and septic pulmonary emboli. Extension of thrombosis to cranial venous sinuses is rarely reported and simultaneous extension to cranial venous sinuses and superior vena cava (SVC) has not been previously reported.

Aims: We present the first case of an infant with Lemierre syndrome with simultaneous thrombus extension to cranial venous sinuses and SVC, managed successfully.

Methods: Retrospective review of electronic medical record of an infant with Lemierre syndrome and collection of case details including laboratory/imaging results, management and outcome.

Results: A twelve-month-old male presented with two weeks history of fever, otitis media, and right-sided facial/neck swelling. Clinical findings and imaging revealed extensive suppurative abscesses from neck to the mediastinum, extensive thrombophlebitis and thrombosis extending from sigmoid and transverse sinuses, through right facial and internal jugular veins, terminating in the SVC. Antibiotics were started and patient underwent incision and drainage. Cultures of the purulent material grew MRSA. Post-operatively, patient was started on therapeutic unfractionated heparin, and transitioned to therapeutic enoxaparin after four days. Patient completed six months of anticoagulation outpatient with clinical improvement, and radiologic thrombus resolution.

Conclusion(s): Only few cases of Lemierre syndrome have been described in children with thrombus extension to cranial venous sinuses and only one report with SVC thrombosis shown at autopsy. Simultaneous thrombus extension to the cranial venous sinuses and SVC is a rare, serious complication of Lemierre syndrome as seen in our patient, not described previously. Our case illustrates the severity of Lemierre syndrome, and the successful management with prompt institution of appropriate antibiotics and therapeutic anticoagulation.

Image

Lack of contrast opacification of internal jugular vein -superior arrow- and extension into the SVC -inferior arrow-.

Image

Lack of contrast opacification of the right transverse and sigmoid sinus.

To cite this abstract in AMA style:

Connors J, Montanez N, Srivaths L. Extensive thrombosis from cranial venous sinuses to superior vena cava in an infant with Lemierre syndrome with successful management [abstract]. https://abstracts.isth.org/abstract/extensive-thrombosis-from-cranial-venous-sinuses-to-superior-vena-cava-in-an-infant-with-lemierre-syndrome-with-successful-management/. Accessed September 24, 2023.

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