Lemierre’s Syndrome: The Controversy of Anticoagulation

In this issue of Pediatrics, Schmid et al¹  present an important case of respiratory failure and hypercoagulability in a toddler with Lemierre’s syndrome (LS). The first significant finding is the young age of the patient. Given the increasing prevalence of LS, one needs to have a high index of suspicion in all pediatric age groups, not just adolescents.^2,3  The second important finding includes the potential implications of screening for and finding underlying thrombophilia. In addition, the possibility of underlying thrombophilia predisposing one to LS is a novel concept.

Internal jugular venous thrombosis is the hallmark of LS, but the role of anticoagulation is controversial.^4,5  One potential indication for anticoagulation is a cerebral infarct or sinus venous thrombosis.⁶  In 1 case of cavernous sinus thrombosis in the setting of LS, the patient was treated with aspirin.⁶  Another case report documented the...