A 3.5-year-old healthy boy with 4 days of fever was referred to the emergency department for respiratory distress. The physical examination was remarkable for stupor, tachycardia, tachypnea, and dyspnea. Initial blood tests showed pancytopenia. He rapidly developed torticollis. Computerized tomography of the neck revealed a thrombus in the internal jugular vein. A presumptive diagnosis of Lemierre's syndrome was made and he was started on antibiotics and anticoagulation. He subsequently developed adult respiratory distress syndrome and required high frequency oscillatory ventilation for 9 days. Blood cultures were positive for Fusobacterium necrophorum. Screening for hypercoagulability revealed 2 known risk factors: a mutation in the prothrombin gene and elevated lipoprotein a.
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May 01 2005
Respiratory Failure and Hypercoagulability in a Toddler With Lemierre's Syndrome
Tal Schmid, MD;
Tal Schmid, MD
*Pediatric Intensive Care Unit
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Hagit Miskin, MD;
Hagit Miskin, MD
‡Pediatric Hematology Unit
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Yechiel Schlesinger, MD;
Yechiel Schlesinger, MD
§Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
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Zvi Argaman, MD;
Zvi Argaman, MD
*Pediatric Intensive Care Unit
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David Kleid, MD
David Kleid, MD
*Pediatric Intensive Care Unit
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Reprint requests to (D.K.) Pediatric Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel. E-mail: kleid@szmc.org.il
Pediatrics (2005) 115 (5): e620–e622.
Article history
Accepted:
November 29 2004
Citation
Tal Schmid, Hagit Miskin, Yechiel Schlesinger, Zvi Argaman, David Kleid; Respiratory Failure and Hypercoagulability in a Toddler With Lemierre's Syndrome. Pediatrics May 2005; 115 (5): e620–e622. 10.1542/peds.2004-2505
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