Wu Meng-Yu, Hou Yueh-Tseng, Ke Jian-Yu, Yiang Giou-Teng
Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.
Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan.
Tzu Chi Med J. 2019 Jun 6;32(1):91-95. doi: 10.4103/tcmj.tcmj_34_19. eCollection 2020 Jan-Mar.
Internal jugular vein thrombosis is a rare critical cardiovascular emergency, which has potential catastrophic clinical outcomes by resulting in stroke and pulmonary embolism. Several etiologies have been reported; however, there are limited data on Lemierre's and Trousseau's syndromes, which are both rare conditions with advanced disease progression and poor clinical outcomes. Lemierre's syndrome may present with typical progressively infectious symptoms and signs, including sore throat, neck mass, and fever, whereas Trousseau's syndrome may present with thrombophlebitis and painful edema. Without antibiotic agents controlling the infection, the condition of patients with Lemierre's syndrome may progress to sepsis or septic shock. The infection pattern plays an important role for differential diagnosis. Herein, we describe the case of a 46-year-old woman presenting with atypical symptoms of Trousseau's syndrome mimicking Lemierre's syndrome. Laboratory analysis including protein C, protein S, rheumatoid factor, and antinuclear antibody ruled out hypercoagulopathy and autoimmune vasculitis. Abdominal computed tomography and panendoscopy revealed ulcerative tumor at the antrum. Pathological examination confirmed the presence of signet-ring cell adenocarcinoma. We highlight the clinical features and etiologies of internal jugular vein thrombosis, especially in Lemierre's syndrome and Trousseau's syndrome, to aid physicians in making an early diagnosis and providing timely management.
颈内静脉血栓形成是一种罕见的严重心血管急症，可导致中风和肺栓塞，具有潜在的灾难性临床后果。已有多种病因被报道；然而，关于勒米尔综合征和特鲁索综合征的数据有限，这两种都是罕见疾病，疾病进展迅速且临床预后较差。勒米尔综合征可能表现为典型的进行性感染症状和体征，包括咽痛、颈部肿块和发热，而特鲁索综合征可能表现为血栓性静脉炎和疼痛性水肿。如果没有抗生素控制感染，勒米尔综合征患者的病情可能进展为脓毒症或感染性休克。感染模式在鉴别诊断中起着重要作用。在此，我们描述了一例46岁女性患者，其表现为类似勒米尔综合征的特鲁索综合征非典型症状。包括蛋白C、蛋白S、类风湿因子和抗核抗体在内的实验室分析排除了高凝血症和自身免疫性血管炎。腹部计算机断层扫描和全内镜检查显示胃窦部有溃疡性肿瘤。病理检查证实存在印戒细胞腺癌。我们强调颈内静脉血栓形成的临床特征和病因，尤其是在勒米尔综合征和特鲁索综合征中，以帮助医生早期诊断并及时进行治疗。
