Velagapudi P, Turagam Mohit, Are C, Patel H, Yekkirala L
Department of Internal Medicine, University of Illinois, Urbana-Champaign, USA.
ScientificWorldJournal. 2009 May 20;9:331-2. doi: 10.1100/tsw.2009.44.
Lemierre's syndrome is a rare but a life threatening condition which affects young healthy individuals, was first described by Dr.Andre Lemierre in 1936. Incidence rates are between 0.6 and 2.3 per million population. It is found more commonly in males, with a male to female ratio of approximately 2:1. Its pathogenesis consists of the development of infectious thrombophlebitis in the internal jugular vein or one of its branches caused by a focal sepsis, mostly localized in the oropharynx, leading to generalized multiorgan metastatic infections, generally to the lung. This computerized tomography (CT) neck with intravenous contrast is from a 24 year old female who presented with a two day history of fever, hypotension and respiratory failure. The physical exam was positive for diminished breath sounds bilaterally on lung exam. Complete blood count revealed a leukocytosis of 16,200 u/L with 70% neutrophils and 9% bands, hemoglobin of 13.4mg/dl and severe thrombocytopenia with a platelet count of 34,000 u/L; comprehensive metabolic panel revealed sodium 140mmol/L, potassium 2.9mmol/L, bicarbonate 26mmol/L, blood urea nitrogen (BUN) 16mg/dl, creatinine 0.8mg/dl, calcium 7.2 mg/dl, albumin 2.4g/dl, total bilurubin 3.1mg/dl, AST 81 U/L, ALK 101 U/L, ALT 35U/L. CT chest revealed multiple cavitary opacities in both lungs. Blood cultures were positive for Fusobacterium necrophorum. CT scan neck showed a filling defect of the right internal jugular vein consistent with a thrombus and multiple enlarged cervical lymph nodes. Treatment is medical with intravenous antibiotics and anticoagulation. References: 1. Carlson ER, Bergamo DF, Coccia CT. Lemierre's syndrome: two cases of a forgotten disease. J Oral Maxillofac Surg 1994; 52:74-78. 2. Moore-Gillon J, Lee TH, Eykyn SJ, Phillips I. Necrobacillosis: a forgotten disease. BMJ 1984;288:1526-1527. 3. Jones C, Siva TM, Seymour FK, O'Reilly BJ. Lemierre's syndrome presenting with peritonsillar abscess and VIth cranial nerve palsy. J Laryngol Otol 2006;120:502-504 4. Mohammed Iqbal Syed et al. Lemierre Syndrome: Two Cases and a Review. Laryngoscope, 117:1605-1610, 2007 5. Vohra A, Saiz E, Ratzan KR. A young woman with a sore throat, septicaemia, and respiratory failure. Lancet 1997; 350:928.
勒米尔氏综合征是一种罕见但危及生命的疾病，主要影响年轻健康个体，于1936年由安德烈·勒米尔博士首次描述。发病率为每百万人中有0.6至2.3例。该病在男性中更为常见，男女比例约为2:1。其发病机制是由局灶性脓毒症引起的颈内静脉或其分支之一的感染性血栓性静脉炎，多数局限于口咽部，进而导致全身多器官转移性感染，通常转移至肺部。这张颈部增强计算机断层扫描（CT）图像来自一名24岁女性，她有两天的发热、低血压和呼吸衰竭病史。体格检查发现肺部双侧呼吸音减弱。血常规显示白细胞计数为16,200 u/L，中性粒细胞占70%，杆状核细胞占9%，血红蛋白为13.4mg/dl，严重血小板减少，血小板计数为34,000 u/L；综合代谢指标显示钠140mmol/L，钾2.9mmol/L，碳酸氢根26mmol/L，血尿素氮（BUN）16mg/dl，肌酐0.8mg/dl，钙7.2mg/dl，白蛋白2.4g/dl，总胆红素3.1mg/dl，谷草转氨酶（AST）81 U/L，碱性磷酸酶（ALK）101 U/L，谷丙转氨酶（ALT）35U/L。胸部CT显示双肺有多个空洞性混浊。血培养坏死梭杆菌呈阳性。颈部CT扫描显示右颈内静脉有充盈缺损，符合血栓形成，并有多个肿大的颈部淋巴结。治疗方法是静脉使用抗生素和抗凝药物。参考文献：1. Carlson ER, Bergamo DF, Coccia CT. Lemierre's syndrome: two cases of a forgotten disease. J Oral Maxillofac Surg 1994; 52:74 - 78. 2. Moore - Gillon J, Lee TH, Eykyn SJ, Phillips I. Necrobacillosis: a forgotten disease. BMJ 1984;288:1526 - 1527. 3. Jones C, Siva TM, Seymour FK, O'Reilly BJ. Lemierre's syndrome presenting with peritonsillar abscess and VIth cranial nerve palsy. J Laryngol Otol 2006;120:502 - 504 4. Mohammed Iqbal Syed et al. Lemierre Syndrome: Two Cases and a Review. Laryngoscope, 117:1605 - 1610, 2007 5. Vohra A, Saiz E, Ratzan KR. A young woman with a sore throat, septicaemia, and respiratory failure. Lancet 1997; 350:928.
