Int J Clin Pediatr

International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access

Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc

Journal website http://www.theijcp.org

Case Report

Volume 9, Number 1, March 2020, pages 4-8

Lemierre’s Syndrome: A Case Report of a Child With Partial Treatment of Streptococcal Pharyngitis

Figure 1. (a) Contrast-enhanced computed tomography image of the neck in the sagittal plane demonstrating the thrombosed right internal jugular vein (blue arrows). (b) Contrast-enhanced computed tomography axial image of neck showing the thrombosed right internal jugular vein (blue arrow) compared to the patent left internal jugular vein (red arrow). (c) Axial contrast-enhanced computed tomography at the base of the skull at the level of the jugular foramen. The right internal jugular vein is thrombosed (blue arrow) compared to the patent left internal jugular vein (red arrow).

**Table 1.** Patient’s Laboratory Results With Associated Reference Ranges at the Time of Diagnosis of Lemierre’s Syndrome
Components	Value (latest reference range)
White blood cell count (WBC)	9.5 × 10³ (4.0 - 10.0 ×10³/mm³)
Red blood cell count (RBC)	4.16 × 10⁶ (4.00 - 5.20 × 10⁶/µL)
Hemoglobin	12.1 (12.0 - 16.0 g/dL)
Hematocrit	37.5 (35.0-45.0%)
Mean corpuscular volume (MCV)	90.1 (78.0 - 100.0 fL)
Mean corpuscular hemoglobin (MCH)	29.0 (26.0 - 34.0 pg)
Mean corpuscular hemoglobin concentration (MCHC)	32.2 (31.0 - 37.0 g/dL)
Red cell distribution width (RDW)	12.6 (11.0-14.0 %)
Platelet count	843 × 10³ (H) (150 - 450 ×10³/mm³)
Mean platelet volume (MPV)	7.1 (6.0 - 10.0 fL)
Neutrophils	57.9 (40.0-80.0%)
Lymphocytes	35.3 (20.0-45.0%)
Monocytes	3.8 (2.0-10.0%)
Eosinophils	0.8 (0.0-8.0%)
Basophils	0.0 (0.0-2.0%)
DIFF type	Auto Diff
Neutrophils absolute	5.53 × 10³ (1.70 - 7.00 ×10³/µL)
Lymphocytes absolute	3.37 × 10³ (1.00 - 3.20 ×10³/µL)
Monocytes absolute	0.36 × 10³ (0.20 - 0.70 ×10³/µL)
Eosinophils absolute	0.07 × 10³ (0.03 - 0.46 ×10³/µL)
Basophils absolute	0.08 × 10³ (0.02 - 0.09 ×10³/µL)
Sodium	139 (136 - 145 mmol/L)
Potassium, serum	3.7 (3.3 - 5.1 mmol/L)
Chloride, serum	99 (98 - 107 mmol/L)
Carbon dioxide total	27 (22 - 30 mmol/L)
Urea nitrogen	8 (6 - 21 mg/dL)
Creatinine	0.89 (0.49 - 0.84 mg/dL)
Glucose, serum	97 (65 - 99 mg/dL)
Calcium, serum	9.9 (8.4 - 10.2 mg/dL)
Anion gap	13 (8 - 16 mmol/L)
C-reactive protein (CRP), high sensitivity	12.4 (H) (0.0 - 4.9 mg/L)
Erythrocyte sedimentation rate (ESR)	97 (H) (0 - 20 mm/h)
Aspartate transaminase (AST)	21 (0 - 37 U/L)
Alanine transaminase (ALT)	27 (0 - 41 U/L)

Table 1. Patient’s Laboratory Results With Associated Reference Ranges at the Time of Diagnosis of Lemierre’s Syndrome

Components

Value (latest reference range)

White blood cell count (WBC)

9.5 × 10³ (4.0 - 10.0 ×10³/mm³)

Red blood cell count (RBC)

4.16 × 10⁶ (4.00 - 5.20 × 10⁶/µL)

Hemoglobin

12.1 (12.0 - 16.0 g/dL)

Hematocrit

37.5 (35.0-45.0%)

Mean corpuscular volume (MCV)

90.1 (78.0 - 100.0 fL)

Mean corpuscular hemoglobin (MCH)

29.0 (26.0 - 34.0 pg)

Mean corpuscular hemoglobin concentration (MCHC)

32.2 (31.0 - 37.0 g/dL)

Red cell distribution width (RDW)

12.6 (11.0-14.0 %)

Platelet count

843 × 10³ (H) (150 - 450 ×10³/mm³)

Mean platelet volume (MPV)

7.1 (6.0 - 10.0 fL)

Neutrophils

57.9 (40.0-80.0%)

Lymphocytes

35.3 (20.0-45.0%)

Monocytes

3.8 (2.0-10.0%)

Eosinophils

0.8 (0.0-8.0%)

Basophils

0.0 (0.0-2.0%)

DIFF type

Auto Diff

Neutrophils absolute

5.53 × 10³ (1.70 - 7.00 ×10³/µL)

Lymphocytes absolute

3.37 × 10³ (1.00 - 3.20 ×10³/µL)

Monocytes absolute

0.36 × 10³ (0.20 - 0.70 ×10³/µL)

Eosinophils absolute

0.07 × 10³ (0.03 - 0.46 ×10³/µL)

Basophils absolute

0.08 × 10³ (0.02 - 0.09 ×10³/µL)

Sodium

139 (136 - 145 mmol/L)

Potassium, serum

3.7 (3.3 - 5.1 mmol/L)

Chloride, serum

99 (98 - 107 mmol/L)

Carbon dioxide total

27 (22 - 30 mmol/L)

Urea nitrogen

8 (6 - 21 mg/dL)

Creatinine

0.89 (0.49 - 0.84 mg/dL)

Glucose, serum

97 (65 - 99 mg/dL)

Calcium, serum

9.9 (8.4 - 10.2 mg/dL)

Anion gap

13 (8 - 16 mmol/L)

C-reactive protein (CRP), high sensitivity

12.4 (H) (0.0 - 4.9 mg/L)

Erythrocyte sedimentation rate (ESR)

97 (H) (0 - 20 mm/h)

Aspartate transaminase (AST)

21 (0 - 37 U/L)

Alanine transaminase (ALT)

27 (0 - 41 U/L)