Lemierre syndrome and influenza A (H1N1)

Lemierre syndrome is an anaerobic bacteremia associated with a septic thrombophlebitis of the internal jugular vein. Septic emboli can be found in many organs. It often occurs after pharyngitis. Today, Lemierre syndrome is quite rare, but without rapid treatment, it may become life-threatening. A 4-year-old child presented with a febrile headache and torticollis. He was influenza A (H1N1)-positive. He also had beta-hemolytic streptococcal pharyngitis. A secondary CT scan was taken because of clinical worsening (non reducible torticollis). Parapharyngeal abscess and septic thrombophlebitis in the left jugular vein were revealed. In spite of negative blood cultures, our patient may have presented Lemierre syndrome. The outcome was favorable using intravenous antibiotics (metronidazole and penicillin) and curative anticoagulation. The thrombophlebitis vanished during a 2-month course of anticoagulation. Lemierre syndrome may occur after viral infections such as EBV or CMV infections. Like those viruses, influenza A (H1N1) virus may induce transient immunosuppression that predisposes to bacterial infections. Our patient had Lemierre syndrome occurring during an influenza A (H1N1) infection.