Habib Saad, Rajdev Kartikeya, Siddiqui A H, Azam Mohammed, Memon Asma, Chalhoub Michel
Department of Internal Medicine, Staten Island University Hospital, USA.
Department of Pulmonary & Critical Care, Staten Island University Hospital, USA.
Respir Med Case Rep. 2019 Jun 2;28:100867. doi: 10.1016/j.rmcr.2019.100867. eCollection 2019.
Fusobacterium necrophorum plays a causal role in a rare and life-threatening condition, Lemierre's syndrome. It is characterized by infection involving the posterior compartment of the lateral pharyngeal space complicated by septic suppurative thrombophlebitis of the internal jugular vein with F. necrophorum bacteremia and metastatic abscesses, primarily to the lung and pulmonary septic emboli. Herein, we present a very rare case of oropharyngeal infection complicated by Lemierre's syndrome with characteristic septic emboli to the lungs presenting as sore throat in a previously healthy patient. A 23-year-old woman presented with sore throat and was found to be in sepsis and acute kidney injury. She was found to have septic emboli in lung and Streptococcus anginosus and F. necrophorum in blood. She was diagnosed with Lemierre's syndrome and successfully treated with antibiotics. Lemierre's syndrome should be included in the differential diagnosis in young patients who deteriorate in the setting of a sore throat. If the suspicion is high, throat swabs from young patients with nonstreptococcal group A tonsillitis should be cultured anaerobically on selective medium to detect the presence of F. necrophorum. While clinicians of the infectious disease team may be familiar with this condition other departments including internal medicine and critical care team may less so. Unless clinicians are aware of this syndrome, diagnosis and treatment can be delayed leading to higher morbidity and mortality.
坏死梭杆菌在一种罕见且危及生命的疾病——勒米尔综合征中起致病作用。其特征为累及咽外侧间隙后间隙的感染，并伴有颈内静脉化脓性血栓性静脉炎、坏死梭杆菌菌血症及转移性脓肿，主要转移至肺部并形成肺脓毒性栓子。在此，我们报告一例极为罕见的口咽感染合并勒米尔综合征的病例，该病例具有典型的肺部脓毒性栓子，表现为一名既往健康患者出现咽痛。一名23岁女性因咽痛就诊，被发现患有脓毒症和急性肾损伤。她被发现肺部有脓毒性栓子，血液中存在咽峡炎链球菌和坏死梭杆菌。她被诊断为勒米尔综合征，并通过抗生素治疗成功治愈。对于咽痛病情恶化的年轻患者，应将勒米尔综合征纳入鉴别诊断。如果怀疑度较高，对于非A组链球菌性扁桃体炎的年轻患者，应在选择性培养基上进行厌氧培养咽拭子，以检测坏死梭杆菌的存在。虽然传染病团队的临床医生可能熟悉这种疾病，但包括内科和重症监护团队在内的其他科室可能了解较少。除非临床医生知晓这种综合征，否则诊断和治疗可能会延迟，导致更高的发病率和死亡率。
