Cloutet Alexandra, Botta Ramya Krishna, Kulkarni Shreedhar R, Ponna Pramod Kumar
Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, USA.
Division of Infectious Disease, Vanderbilt University Medical Center, Nashville, USA.
Cureus. 2022 Mar 23;14(3):e23420. doi: 10.7759/cureus.23420. eCollection 2022 Mar.
Lemierre's syndrome is a rare disease that generally occurs in young, healthy individuals, where an index of suspicion for something so serious is often low. There is no standardized definition of Lemierre's syndrome, which has led to a dilemma if Lemierre's can be diagnosed without internal jugular vein (IJV) thrombophlebitis. We highlight a complex case of Lemierre's syndrome that deviates from the classical presentation of the disease. A 31-year-old male presented to the hospital with "throat swelling" and difficulty swallowing. He was in severe sepsis with end-organ damage. The patient developed severe pneumonia with pleural/pericardial effusions and bilateral nodular necrosed lesions during hospitalization. A facial vein thrombus was diagnosed, but the absence of internal jugular vein involvement initially delayed Lemierre's diagnosis. However, blood culture speciation revealed which supported the suspected diagnosis. Persistent fevers and leukocytosis complicated the hospital course despite appropriate antibiotic coverage. The patient ultimately required bilateral thoracotomy and a pericardial window. He made a full recovery.
勒米尔综合征是一种罕见疾病，通常发生在年轻健康个体中，对于如此严重疾病的怀疑指数往往较低。目前尚无勒米尔综合征的标准化定义，这导致了一个两难问题，即如果没有颈内静脉血栓性静脉炎，能否诊断为勒米尔综合征。我们重点介绍了一例偏离该疾病经典表现的复杂勒米尔综合征病例。一名31岁男性因“咽喉肿胀”和吞咽困难入院。他处于严重脓毒症状态，伴有器官功能损害。患者在住院期间发展为严重肺炎，伴有胸腔/心包积液以及双侧结节状坏死病变。诊断出面部静脉血栓，但最初颈内静脉未受累延误了勒米尔综合征的诊断。然而，血培养鉴定结果支持了疑似诊断。尽管给予了适当的抗生素治疗，但持续发热和白细胞增多使住院病程复杂化。患者最终需要进行双侧开胸手术和心包开窗术。他完全康复了。
