Rahhal Hassan, de Campos Fernando Peixoto Ferraz, Ferreira Cristiane Rubia, Felipe-Silva Aloisio
Department of Internal Medicine - Hospital das Clínicas - University of São Paulo, São Paulo/SP - Brazil .
Internal Medicine Division - Hospital Universitário - University of São Paulo, São Paulo/SP - Brazil .
Autops Case Rep. 2015 Sep 30;5(3):11-20. doi: 10.4322/acr.2015.015. eCollection 2015 Jul-Sep.
Lemierre's syndrome (LS), described in detail in 1936, used to be a life-threatening entity until the advent of antibiotics. Tonsillitis or pharyngitis are the main primary infections and oropharyngeal anaerobic flora is the predominant etiology. However, other primary site infections, as well as other microbiological agents have been reported since the first description. Inflammatory symptoms in the neck and marked findings on physical examination predominate the majority of cases. Nonetheless, the authors report the case of a 54-year-old man with a history of dysphagia followed by cough, purulent expectoration, and fever. The bad condition of his dentition was noteworthy. During the diagnostic work-up, an ulcerated lesion in the uvula and a middle lobe pneumonia were disclosed. Streptococcus viridans was isolated from blood culture. On the fifth day of hospitalization, the patient died after a copious episode of hemoptysis. The autopsy findings depicted an abscess within a squamous cell carcinoma of the uvula, pharyngitis with carotid sheath spreading accompanied by pylephlebitis and thrombosis of the internal jugular vein up to the innominate vein, surrounded by an abscess in the mediastinum. Alveolar hemorrhage and pneumonia were also present. We conclude that the ulcerated carcinoma of the uvula housed an abscess, facilitated by the poor oral hygiene, which triggered LS and the descending mediastinitis. Pulmonary involvement was due to the septic embolism from the internal jugular vein. We would like to highlight the uvula abscess as the primary site of infection in this case of LS with S. viridans as the causative agent.
勒米尔综合征（LS）于1936年被详细描述，在抗生素出现之前，它曾是一种危及生命的疾病。扁桃体炎或咽炎是主要的原发性感染，口咽厌氧菌群是主要病因。然而，自首次描述以来，也有其他原发性感染部位以及其他微生物病原体的报道。颈部的炎症症状和体格检查中的明显发现是大多数病例的主要表现。尽管如此，作者报告了一例54岁男性病例，该患者有吞咽困难病史，随后出现咳嗽、脓性咳痰和发热。其牙齿状况不佳值得注意。在诊断检查过程中，发现悬雍垂有溃疡病变和中叶肺炎。血培养分离出草绿色链球菌。住院第五天，患者在大量咯血后死亡。尸检结果显示悬雍垂鳞状细胞癌内有脓肿，咽炎伴颈动脉鞘扩散，伴有门静脉炎和颈内静脉直至无名静脉的血栓形成，周围纵隔有脓肿。还存在肺泡出血和肺炎。我们得出结论，悬雍垂溃疡癌内有脓肿，因口腔卫生差而加重，引发了勒米尔综合征和下行性纵隔炎。肺部受累是由于颈内静脉的脓毒性栓塞。我们想强调在这例由草绿色链球菌作为病原体的勒米尔综合征病例中，悬雍垂脓肿是感染的主要部位。
