Ogi Manabu, Takahashi Kuniyuki, Morita Yuka, Horii Arata
Department of Otolaryngology, Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
J Int Adv Otol. 2021 Sep;17(5):461-464. doi: 10.5152/iao.2021.20142.
Lemierre's syndrome is characterized by internal jugular vein thrombosis and systemic septic embolism; it is a fatal complication of upper respiratory tract infections. To date, it has not been demonstrated how the upper respiratory tract inflammation spreads from the primary infection site to internal jugular vein and systemic thrombosis. We report a very rare case of Lemierre's syndrome derived from malignant otitis externa in which the spread of infection and thrombosis process were identified by imaging. A 61-year-old man with severe diabetes mellitus visited our hospital with consciousness disturbance and right posterior neck pain. He complained of right ear pain and otorrhea several days prior to the neck pain. Contrast-enhanced computed tomography demonstrated thrombosis in internal jugular vein and multiple lung abscesses. Temporal bone images revealed continuous lesions from skull base osteomyelitis to suboccipital abscess and sigmoid sinus thrombosis. We diagnosed the patient as having Lemierre's syndrome secondary to skull base osteomyelitis following malignant otitis externa. The patient clinically recovered with a combination of drainage of suboccipital abscess and long-term administration of antibiotics, which is the standard treatment of malignant otitis externa. Considering the details of imaging and bacterial examination is very useful for understanding the pathophysiology and determining appropriate treatment in Lemierre's syndrome pathophysiology and determining appropriate treatment in Lemierre's syndrome.
勒米尔综合征的特征是颈内静脉血栓形成和全身性脓毒性栓塞；它是上呼吸道感染的一种致命并发症。迄今为止，尚未证实上呼吸道炎症是如何从原发感染部位蔓延至颈内静脉和全身性血栓形成的。我们报告了一例非常罕见的源自恶性外耳道炎的勒米尔综合征病例，其中感染和血栓形成过程通过影像学得以明确。一名61岁的重度糖尿病男性因意识障碍和右后颈部疼痛前来我院就诊。他在颈部疼痛数天前就已出现右耳疼痛和耳漏。增强计算机断层扫描显示颈内静脉血栓形成以及多个肺脓肿。颞骨影像显示从颅底骨髓炎到枕下脓肿和乙状窦血栓形成的连续性病变。我们诊断该患者为恶性外耳道炎继发颅底骨髓炎所致的勒米尔综合征。患者通过枕下脓肿引流和长期使用抗生素联合治疗后临床康复，这是恶性外耳道炎的标准治疗方法。考虑影像学和细菌学检查的细节对于理解勒米尔综合征的病理生理学以及确定适当治疗非常有用。
