CASE REPORT A case of the otogenic variant of Lemierre’s syndrome with atypical sequelae and a review of pediatric literature Tami Masterson a , H. El-Hakim b, * , Ken Magnus c , Joan Robinson a a Department of Pediatrics, The Stollery Children’s Hospital, Edmonton, Alta., Canada b The Subdivision of Pediatric Otolaryngology, The Stollery Children’s Hospital, Edmonton, Canada c Department of Radiology, The Stollery Children’s Hospital, Edmonton, Canada Received 5 April 2004; received in revised form 24 July 2004; accepted 25 July 2004 1. Introduction Lemierre’s syndrome (LS) is classically described, as septic thrombosis of the internal jugular vein (IJV), most commonly secondary to acute pharyngitis (anaerobic postanginal septicaemia) [1]. The etio- logic agent is usually Fusobacterium necrophorum (literally, ‘‘spindle shaped rod bringingdeath’’), an anaerobic Gram-negative rod which is a commensal in the oral cavity, gastrointestinal and urinary tract. The trigger that leads to the organism penetrating the mucosa is unknown, but reduced host defenses by viral and other bacterial infections is thought to play a role [2]. With some variability between the subspecies, the organism produces hemolysin, lipase and hemagluttinin, bearing in mind that only the necrophorum subspecies is able to aggregate human platelets. Following the acute pharyngitis, intravascular coagulation caused by platelet aggre- gation may contribute to establishing favorable anaerobic environment leading to progressive thrombophlebitis and bacteraemia. The process is International Journal of Pediatric Otorhinolaryngology (2005) 69, 117—122 www.elsevier.com/locate/ijporl KEYWORDS Lemierre’s syndrome; Sigmoid sinus thrombosis; Hearing loss; Fusobacterium necrophorum; Necrobacillosis Summary We report a case of an 8-year-old girl who presented with the clinical picture of Lemierre’s syndrome (LS) secondary to bilateral mastoiditis. She developed unilateral sensorineural hearing loss (SNHL) along with internal jugular vein (IJV) thrombosis, septic arthritis of her ankle and cervical fasciitis. Combined antimicro- bial, anticoagulant and surgical treatment helped reverse all the effects of the sequelae, including nearly all the hearing loss. This is a unique case of this uncommon variant of the syndrome and with an uncommonly reported complication. The literature indicates that pediatric cases are a minority and enforces that successful management rests on awareness of the condition, vigil and promptness of commu- nication of a multidisciplinary pediatric team. # 2004 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Present address: Subdivision of Pedia- trics Otolaryngology, 2C3.59 Walter MacKenzie Centre, 8440-112 Street, Edmonton, Alta., Canada T6G 2B7. Tel.: +1 780 407 8629; fax: +1 780 407 7136. E-mail address: Haelhakim@cha.ab.ca (H. El-Hakim). 0165-5876/$ — see front matter # 2004 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijporl.2004.07.023