Ge Jie, Zhou Peipei, Yang Yifei, Xu Tianshu, Yang Xu
Department of stomatology, Changzhou First People's Hospital, Juqian Street, Changzhou, 185, Jiangsu, China.
Thromb J. 2021 Nov 4;19(1):80. doi: 10.1186/s12959-021-00336-0.
Lemierre syndrome (LS) is characterized by multisystemic infection beginning in the oropharynx, local thrombophlebitis (typically, of the internal jugular vein) and peripheral embolism. No evidence-based guidelines exist for the management of this disease, and the use of anticoagulation therapy remains particularly controversial.
A 61-year-old man presenting with left neck swelling, odynophagia, and dyspnea underwent emergency surgery and received intravenous antibiotics. The primary infection was controlled on hospital day 5, but on day 6 sudden leukocytosis and hypoxemia were observed. CT angiography revealed an intraluminal filling defect in the pulmonary artery on day 8. LS was diagnosed and anticoagulation therapy was initiated. The WBC count, which had maintained its peak values in the previous 2 days, decreased instantly after initiation, and follow-up controls showed thrombus resolution.
Our case supports the notion that anticoagulation therapy may be a valid supplement to antimicrobial therapy in LS, especially in the presence of a possibly young thrombus as suggested by clinical worsening.
勒米尔综合征（LS）的特征是始于口咽的多系统感染、局部血栓性静脉炎（通常为颈内静脉）和外周栓塞。目前尚无基于证据的该病管理指南，抗凝治疗的使用仍存在特别大的争议。
一名61岁男性，出现左颈部肿胀、吞咽痛和呼吸困难，接受了急诊手术并接受静脉抗生素治疗。原发性感染在住院第5天得到控制，但在第6天观察到突然的白细胞增多和低氧血症。CT血管造影在第8天显示肺动脉腔内充盈缺损。诊断为勒米尔综合征并开始抗凝治疗。白细胞计数在之前两天一直维持在峰值，开始治疗后立即下降，后续检查显示血栓溶解。
我们的病例支持这样一种观点，即抗凝治疗可能是勒米尔综合征抗菌治疗的有效补充，特别是在临床恶化提示可能存在新鲜血栓的情况下。
