Moore Brian A, Dekle Catherine, Werkhaven Jay
Department of Otolaryngology-Head and Neck Surgery, Suite 2900 TVC, Vanderbilt University Medical Center, Nashville, TN 37232-5555, USA.
Ear Nose Throat J. 2002 Apr;81(4):234-6, 238-40, 242 passim.
Lemierre's syndrome is characterized by thrombosis of the internal jugular vein that develops following an oropharyngeal infection. Sepsis and septic metastases frequently ensue and affect the lungs, the musculoskeletal system, and occasionally the liver. Most cases are caused by infection with Fusobacterium necrophorum. This infection responds to antibiotic therapy with beta-lactamase-resistant compounds that exert good anaerobic coverage. Anticoagulation and surgical intervention can be helpful in advanced cases. Fewer than 160 cases of classic Lemierre's syndrome have been described; approximately one-third of these reported cases have occurred since 1988. We describe a new case of Lemierre's syndrome that occurred in an otherwise healthy 27-year-old man. Thrombosis of both internal jugular veins extended through the subclavian system and into both upper extremities. The patient was treated with intravenous antibiotics and heparin during 14 days of hospitalization. He was discharged on oral clindamycin and warfarin sodium, and after 6 months he was able to return to full activity. To our knowledge, this is the first reported case of Lemierre's syndrome in which internal jugular vein thrombosis occurred bilaterally. By reporting this previously undescribed manifestation of Lemierre's syndrome, we hope to increase practitioner awareness of this disease entity.
勒米尔综合征的特征是口咽感染后发生颈内静脉血栓形成。脓毒症和脓毒性转移经常随之发生，并影响肺部、肌肉骨骼系统，偶尔也会影响肝脏。大多数病例由坏死梭杆菌感染引起。这种感染对抗生素治疗有反应，使用具有良好厌氧菌覆盖范围的β-内酰胺酶耐药化合物。在晚期病例中，抗凝和手术干预可能会有帮助。已描述的经典勒米尔综合征病例不到160例；自1988年以来，这些报告病例中约有三分之一发生。我们描述了一例发生在一名27岁健康男性身上的新的勒米尔综合征病例。双侧颈内静脉血栓形成延伸至锁骨下系统并累及双上肢。患者在住院14天期间接受了静脉抗生素和肝素治疗。他出院时服用口服克林霉素和华法林钠，6个月后能够恢复完全活动。据我们所知，这是首例双侧发生颈内静脉血栓形成的勒米尔综合征报告病例。通过报告这种以前未描述过的勒米尔综合征表现，我们希望提高从业者对这种疾病实体的认识。
