Gunatilake Sonali Sihindi Chapa, Yapa Lakmini Gunarathna, Gallala Malinga, Gamlath Rohitha, Rodrigo Chaturaka, Wimalaratna Harith
Department of Medicine, Teaching Hospital, Kandy 20000, Sri Lanka.
Department of Microbiology, Teaching Hospital, Kandy 20000, Sri Lanka.
Int J Emerg Med. 2014 Sep 26;7:39. doi: 10.1186/s12245-014-0039-y. eCollection 2014.
Lemierre's syndrome is a rare condition characterized by thrombophlebitis of internal jugular vein, septicemia and septic metastatic infection of different organs. It is preceded by an oropharyngeal infection by anaerobic organisms. Community-acquired methicillin-resistant Staphylococcus aureus is now emerging as a causative organism in Lemierre's syndrome. Clinical manifestations vary depending on the organ system affected by the infection. Although rare, patients may present with life-threatening conditions such as cardiac tamponade.
We report the first case, to our knowledge, of Lemierre's syndrome presenting with cardiac tamponade secondary to community-acquired methicillin-resistant S. aureus in a previously well 45-year-old Sri Lankan lady. Fever, sore throat and left-sided neck pain complicated with facial and left upper limb swelling were followed by severe shortness of breath for 24 h. There was tachycardia with pulsus paradoxus, low blood pressure and soft heart sounds. Pericardial effusion with cardiac tamponade was detected on echocardiogram and methicillin-resistant S. aureus species were isolated in both blood and pericardial fluid cultures. Venous duplex of neck veins and computed tomography scan of the neck showed thrombosis of left-sided internal jugular, external jugular, subclavian and axillary veins. Diagnosis of Lemierre's syndrome was made, and patient had a satisfactory recovery following emergency pericardiocentesis and a prolonged course of antibiotics.
Although uncommon, Lemierre's syndrome is a life-threatening condition. Patients may present with cardiac tamponade secondary to purulent pericarditis in Lemierre's syndrome, where emergency pericardiocentesis is lifesaving. Community-acquired methicillin-resistant S. aureus is emerging as a causative agent in Lemierre's syndrome, and awareness is required amongst physicians for prompt diagnosis and appropriate empirical treatment to prevent mortality and morbidity associated with the disease.
勒米尔综合征是一种罕见疾病，其特征为颈内静脉血栓性静脉炎、败血症以及不同器官的感染性转移性感染。它由厌氧生物引起的口咽感染引发。社区获得性耐甲氧西林金黄色葡萄球菌现已成为勒米尔综合征的致病病原体。临床表现因受感染的器官系统而异。尽管罕见，但患者可能会出现危及生命的状况，如心脏压塞。
据我们所知，我们报告了首例在一位此前健康的45岁斯里兰卡女性中，由社区获得性耐甲氧西林金黄色葡萄球菌引起的勒米尔综合征并伴有心脏压塞的病例。发热、咽痛和左侧颈部疼痛并伴有面部及左上肢肿胀，随后出现严重气短达24小时。存在心动过速、奇脉、低血压以及心音微弱。超声心动图检测到心包积液并伴有心脏压塞，血液和心包液培养均分离出耐甲氧西林金黄色葡萄球菌。颈部静脉的静脉双功超声检查以及颈部计算机断层扫描显示左侧颈内静脉、颈外静脉、锁骨下静脉和腋静脉血栓形成。做出了勒米尔综合征的诊断，患者在紧急心包穿刺术和长期抗生素治疗后恢复良好。
尽管不常见，但勒米尔综合征是一种危及生命的疾病。在勒米尔综合征中，患者可能会因化脓性心包炎继发心脏压塞，此时紧急心包穿刺术可挽救生命。社区获得性耐甲氧西林金黄色葡萄球菌正成为勒米尔综合征的致病因素，医生需要提高认识以便及时诊断并进行适当的经验性治疗，以预防与该疾病相关的死亡率和发病率。
