Mattke Adrian C, Prabhu Sudesh, Clark Julia, Labrom Robert, Burns Hanna, Schlapbach Luregn J
Queensland Paediatric Cardiac Services, Lady Cilento Children's Hospital (LCCH), South Brisbane, QLD, Australia.
School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
SAGE Open Med Case Rep. 2017 Aug 1;5:2050313X17722726. doi: 10.1177/2050313X17722726. eCollection 2017.
Lemierre's syndrome cause by methicillin-sensitive is rare, but can lead to necrotizing pneumonia and septicaemia. When treating such patient with extracorporeal life support source control can be both challenging and controversial.
In this report we present a 12 year old male who presented with Lemierre's syndrome from which he developed septic shock and severe necrotizing pneumonia. He also showed multiple pulmonary embolisms from the internal jugular vein thrombi, resulting in acute respiratory distress syndrome.
The patient was treated with extracorporeal life support. Subsequent computed tomography revealed multiple abscesses throughout his lungs and around vertebral bodies C1 and C2, for which source control with drainage of the cervical abscesses was achieved while on extracorporeal life support. The necrotizing pneumonia gradually improved, and partial pneumectomy was avoided. He was successfully separated from extracorporeal life support and respiratory support and recovered from his illness. Follow-up imaging showed almost complete resolution of the pulmonary abscesses. Osteomyelitis of C1/C2 and severe muscle wasting required a prolonged hospital stay.
This case highlights the challenges of supporting patients suffering from disseminated staphylococcal sepsis with extracorporeal life support and the key role of source control and demonstrates the value of using extracorporeal life support in necrotizing pneumonia.
由对甲氧西林敏感的细菌引起的勒米尔综合征较为罕见，但可导致坏死性肺炎和败血症。在使用体外生命支持治疗此类患者时，源头控制既具有挑战性又存在争议。
在本报告中，我们介绍了一名12岁男性，他患有勒米尔综合征，并由此发展为感染性休克和严重的坏死性肺炎。他还因颈内静脉血栓形成出现多处肺栓塞，导致急性呼吸窘迫综合征。
该患者接受了体外生命支持治疗。随后的计算机断层扫描显示其肺部以及C1和C2椎体周围有多处脓肿，在接受体外生命支持期间，通过引流颈部脓肿实现了源头控制。坏死性肺炎逐渐好转，避免了部分肺切除术。他成功脱离了体外生命支持和呼吸支持，病情康复。随访影像显示肺脓肿几乎完全消退。C1/C2骨髓炎和严重的肌肉萎缩导致住院时间延长。
本病例突出了使用体外生命支持治疗播散性葡萄球菌败血症患者的挑战以及源头控制的关键作用，并证明了体外生命支持在坏死性肺炎中的应用价值。
