LIFE-THREATENING SORE THROAT IN PEDIATRIC ED LEMIERRE SYNDROME

Sore throat is often underestimated by emergency physicians if the patient has a healthy appearance; however, sore throat can be the initial presentation of some rare life-threatening conditions such as Lemierre syndrome, which is caused by the gram-negative anaerobic bacilli Fusobacterium necrophorum. A 4-year-old boy with a fever was brought to the pediatric emergency department (ED). The patient was already taking oral Amoxicillin with antipyretics for the past 2 days. He was discharged home with the diagnosis of pharyngitis. Two days later, he returned to the ED with additional complaints: neck and abdominal pain, shortness of breath, and a dry cough. According to his presentation, a diagnosis of compensated septic shock secondary to pneumonia, to rule out meningitis, was made, and he was started on intravenous vancomycin and ceftriaxone. The patient was admitted to the pediatric intensive care unit (PICU). A diagnostic work-up that included neck computed tomography (CT) showed that the patient had Lemierre syndrome. In cases of sore throat in children, a high index of clinical suspicion must be raised by emergency physicians to the possibility of Lemierre syndrome so that the appropriate treatment can be initiated.