Internal Medicine, CHUV, Lausanne, Switzerland
Internal Medicine, CHUV, Lausanne, Switzerland.
BMJ Case Rep. 2023 Apr 21;16(4):e254638. doi: 10.1136/bcr-2023-254638.
We present here the challenging case of severe Lemierre syndrome in a healthy woman in her late twenties, whose clinical presentation was characterised by lung abscesses and disseminated systemic abscesses in the brain, the abdomen and the soft-tissues, as a likely consequence of a patent foramen ovale. Blood cultures were positive for and a right lingual vein thrombosis was detected at a late stage when the patient developed a septic shock. Initial antimicrobial therapy with metronidazole and ceftriaxone was modified to meropenem due to progressive worsening. The patient underwent laparoscopy and neurosurgical drainage of a cerebral abscess. She spent many days in the intensive care unit and recovered fully after 6 weeks on meropenem therapy. Although considered rare, the incidence of Lemierre syndrome, a potentially life-threatening condition, is increasing. The clinician should promptly recognise and treat it while being aware of its potential atypical presentations.
我们在此呈现一例严峻的莱姆病综合征病例，患者为健康的 20 多岁女性，其临床表现为肺脓肿和脑、腹部和软组织弥漫性全身脓肿，可能是由于卵圆孔未闭所致。血液培养结果为阳性，在患者发生感染性休克时晚期发现右侧舌静脉血栓形成。由于病情逐渐恶化，初始使用甲硝唑和头孢曲松的抗菌治疗方案改为美罗培南。患者接受了腹腔镜检查和脑脓肿的神经外科引流术。她在重症监护病房度过了许多天，在使用美罗培南治疗 6 周后完全康复。尽管莱姆病综合征被认为罕见，但这种潜在危及生命的疾病的发病率正在增加。临床医生应在认识到其潜在不典型表现的同时，迅速识别并治疗该病。
