Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA.
Department of Internal Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA.
Am J Case Rep. 2021 Sep 29;22:e933587. doi: 10.12659/AJCR.933587.
BACKGROUND Lemierre's syndrome (LS), a potentially fatal condition, is characterized by thrombophlebitis of a head or neck vein secondary to a head or neck infection, most commonly involving Fusobacterium necrophorum. Its association with polycythemia vera (PV) is not well reported despite the predisposition to thrombogenesis. CASE REPORT We present the case of a 66-year-old woman with a known history of polycythemia vera (PV) who presented with 4 days of worsening right-sided neck pain and odynophagia. The physical examination revealed poor oral dentition, mild erythema of the posterior pharyngeal mucosa, and non-erythematous tonsils without exudate. A computed tomography with i.v. contrast of the neck revealed complete thrombosis of the right internal jugular vein (IJV). Treatment was initiated with i.v. antibiotics and anticoagulation, with symptoms improving rapidly within 24 h. She was eventually discharged on apixaban and clindamycin and was encouraged to follow up with her hematologist. CONCLUSIONS PV predisposes patients to a hyper-viscous and prothrombotic state, which may warrant a stronger suspicion of Lemierre's syndrome. In addition, lack of aspirin use for prophylaxis of thrombosis and undiagnosed oral infection are factors to consider when assessing risk factors for Lemierre's syndrome in PV patients.
林氏综合征（LS）是一种潜在致命的疾病，其特征是头颈部静脉血栓形成，继发于头颈部感染，最常见的病原体是坏死梭杆菌。尽管存在血栓形成倾向，但 LS 与真性红细胞增多症（PV）的关联尚未得到充分报道。
我们报告了一例 66 岁女性 PV 病史，因右侧颈部疼痛和咽痛加剧 4 天就诊。体格检查显示口腔牙齿不良，后咽部黏膜轻度红斑，扁桃体无红斑，无渗出。颈部静脉增强 CT 显示右侧颈内静脉完全血栓形成。立即给予静脉抗生素和抗凝治疗，24 小时内症状迅速改善。最终患者出院时服用阿哌沙班和克林霉素，并被鼓励咨询血液科医生。
PV 使患者处于高黏滞和易栓状态，可能需要更强的 LS 怀疑。此外，在评估 PV 患者 LS 的危险因素时，应考虑缺乏阿司匹林预防血栓形成和未诊断的口腔感染等因素。
