Multiple Cranial Nerve Palsies in a Pediatric Case of Lemierre’s Syndrome due to Streptococcus viridans

Background. Lemierre’s syndrome is a rare condition of internal jugular vein thrombosis following oropharyngeal infection. While it usually results from Fusobacterium necrophorum infection, atypical cases associated with other pathogens have been reported. Objective. To describe a unique case of pediatric Lemierre’s syndrome with Streptococcus viridans infection resulting in cavernous sinus thrombosis and oculomotor, trochlear, and abducens nerve palsies. Case Report. A 14-year-old female initially presented after six days of fever, myalgias, and sore throat and was admitted for hyperbilirubinemia and acute kidney injury. She developed a fixed, dilated pupil with complete ophthalmoplegia, ptosis, and severe pain. Imaging revealed retromandibular space abscess, external and internal jugular vein thrombosis, cavernous sinus thrombosis, internal carotid artery stenosis, pulmonary embolism, and bilateral pneumonia. She was diagnosed with Lemierre’s syndrome with cultures positive for Streptococcus viridans and treated with a combination of antibiotics and anticoagulation. Conclusion and Relevance. Both antibiotics and anticoagulation were effective management for this Lemierre’s syndrome patient with cavernous sinus thrombosis. Early diagnosis and treatment of Lemierre’s syndrome is essential. A multidisciplinary treatment team is beneficial for managing the sequelae of this condition.

Cavernous Sinus Thrombosis as Complications of Cellulitis Orbital: Case Report

Background: Cavernous sinus thrombosis is a complication of infection around the face or paranasal sinuses with high morbidity and mortality rates. Cavernous sinus thrombosis is generally caused by septic infection, such as orbital cellulitis. Case Illustrations: A 35-year-old male who came to the neurology polyclinic complained of swelling in the left eyelid, red, watery eyes, blurred vision, difficulty opening the left eye, and the movement of the left eyeball felt normal. The patient had a history of left orbital cellulitis. Laboratory investigations showed an increase in inflammatory markers. The CT scan with contrast showed a hyperdense lesion in the left orbit, suggesting orbital cellulitis. The patient was diagnosed with a cavernous sinus thrombosis due to orbital cellulitis. He was treated with an antibiotic, anticoagulant, and corticosteroid. Three months after treatment, the visual complaints improved, the headache decreased drastically, and we did not find any extraocular muscles weakness. Conclusions: The administration of antibiotics and anticoagulant therapy in patients with cavernous sinus thrombosis has been proven clinically. The use of corticosteroids has not been proven but is strongly suspected to reduce edema caused by compression of the cavernous sinus. Keywords: Cavernous sinus thrombosis, orbital cellulitis. infections.