Fujii Teruhiro, Iwabuchi Yuko, Moriyama Takahito, Uchida Keiko, Nitta Kosaku
Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.
SAGE Open Med Case Rep. 2019 Aug 22;7:2050313X19871782. doi: 10.1177/2050313X19871782. eCollection 2019.
Lemierre syndrome develops in healthy young patients as a result of bacteremia after oral cavity infection. It causes thrombophlebitis in the internal jugular vein. Infection can easily occur during immunosuppressive treatment in patients with systemic lupus erythematosus and become severe. We present a case of Lemierre syndrome in a patient with systemic lupus erythematosus. A 56-year-old woman presented with fever, left lower toothache, and skin symptoms from the left neck to the anterior chest. Clinical presentation and laboratory investigations revealed Lemierre syndrome. The inflammation and thrombus disappeared with antibiotic and anticoagulant therapies. However, transient hypocomplementemia and elevated antinuclear antibody levels were observed during treatment; therefore, a concomitant systemic lupus erythematosus flare was considered. In systemic lupus erythematosus patients with Lemierre syndrome, complement and antinuclear antibody levels are modified, so other indicators should be precisely evaluated, such as levels of urinary protein, sediment, serum creatinine and anti-dsDNA antibody, and systemic lupus erythematosus disease activity index.
勒米尔综合征发生于健康的年轻患者，是口腔感染后菌血症的结果。它会导致颈内静脉血栓性静脉炎。系统性红斑狼疮患者在免疫抑制治疗期间很容易发生感染并加重。我们报告一例系统性红斑狼疮患者发生勒米尔综合征的病例。一名56岁女性出现发热、左下牙痛以及从左颈部到前胸的皮肤症状。临床表现和实验室检查显示为勒米尔综合征。经抗生素和抗凝治疗后，炎症和血栓消失。然而，治疗期间观察到短暂的低补体血症和抗核抗体水平升高；因此，考虑同时发生了系统性红斑狼疮病情活动。在患有勒米尔综合征的系统性红斑狼疮患者中，补体和抗核抗体水平会发生改变，所以应精确评估其他指标，如尿蛋白、沉渣、血清肌酐和抗双链DNA抗体水平以及系统性红斑狼疮疾病活动指数。
