MRSA Bacteremia Associated with Lemierre Syndrome

Abstract

Objective: Community acquired MRSA (CA-MRSA) is a growing health concern. CA-MRSA behaves differently between the adult and pediatric population. Lemierre’s syndrome is septic jugular thrombophlebitis affecting mainly young adults. We intend to identify a possible sub group of Lemierre’s syndrome (LS) associated with CA-MRSA through a case report and literature review.

Method: We review a case report of an 18-year-old athlete admitted for increasing fever, tachycardia, tachypnea, and neck pain. MRSA bacteremia was identified, and following ARDS the patient was intubated. Neck CT showed jugular thrombophlebitis at the skull base. The patient was treated with rifampin, vancomycin, ceftriaxone, and clindamycin.

Results: Following intravenous antibiotic treatment the patient improved and was extubated, and subsequent CT and Doppler showed normal jugular flow. Sterilization of blood cultures predicted improvement. A literature review showed a rise in the past 2 years of LS associated with MRSA all with patients less than 18 years old.

Conclusion: CA-MRSA in the pediatric population is associated with dermatologic infection and trauma. CA-MRSA bacteremia can lead to pulmonary sequela. CA-MRSA associated with pharyngitis, nasopharyngitis, and parapharyngeal lymphadenitis may predispose one to LS. LS can be associated with CA-MRSA. As the CA-MRSA carrier is predominantly nasal, pharyngitis may not be present.