Yoshikawa Hisao, Suzuki Makoto, Nemoto Naohiko, Hara Hidehiko, Hashimoto Go, Otsuka Takenori, Moroi Masao, Nakamura Masato, Sugi Kaoru
Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Japan.
Intern Med. 2011;50(5):447-50. doi: 10.2169/internalmedicine.50.4612. Epub 2011 Mar 1.
A 29-year-old man presented with complaints of fever and pain and itching of his left neck with atopic dermatitis and abrasion. These symptoms had persisted for two days and dullness and fever developed, but the patient did not consult a physician. On the following day, he had a fever of 40°C and redness and swelling of the left neck. He visited a local clinic and was hospitalized with suspected cellulitis. A thrombus was detected in the internal jugular vein on MRI, and he was referred to our hospital. Neck ultrasonography showed the presence of an immovable thrombus in the area from the left internal jugular vein to the left brachiocephalic peripheral vein. Blood analysis indicated a major inflammatory response and juvenile idiopathic thrombophlebitis was suspected. A filter was carefully inserted into the superior vena cava, and anticoagulant therapy and medication with antibiotics led to remission. We present this case as a rare example of a condition mimicking Lemierre syndrome that was caused by dermal infection, and we include a review of the literature.
一名29岁男性因患有特应性皮炎和擦伤,出现发热、左侧颈部疼痛及瘙痒等症状。这些症状持续了两天,随后出现颈部钝痛和发热,但患者未就医。次日,他体温达40°C,左侧颈部红肿。他前往当地诊所就诊,因疑似蜂窝织炎而住院。MRI检查发现颈内静脉有血栓形成,遂转诊至我院。颈部超声显示从左侧颈内静脉至左头臂外周静脉区域存在固定不动的血栓。血液分析提示有明显炎症反应,怀疑为青少年特发性血栓性静脉炎。在上腔静脉小心置入滤网,并给予抗凝治疗及抗生素用药后病情缓解。我们将此病例作为由皮肤感染引起的类似勒米尔综合征的罕见病例进行展示,并对相关文献进行综述。