Lavalle Salvatore, Masiello Edoardo, Cocuzza Salvatore, Pavone Piero, Di Nora Alessandra, Calvo-Henriquez Christian, Lechien Jerome Rene, Yanez Miguel Mayo, Praticò Andrea, Ceccarelli Manuela, Iannella Giannicola, Pace Annalisa, Parisi Federica Maria, Magliulo Giuseppe, Maniaci Antonino
Faculty of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy.
Radiology Unit, Department Clinical and Experimental, Experimental Imaging Center, Vita-Salute San Raffaele University, 20132 Milan, Italy.
Pediatr Rep. 2024 Mar 18;16(1):201-213. doi: 10.3390/pediatric16010018.
Lemierre syndrome is a rare, potentially fatal complication of oropharyngeal infections characterized by septic thrombophlebitis of the internal jugular vein. It primarily affects healthy adolescents and young adults. Its incidence declined after the antibiotic era, but it may have resurged in recent decades, likely due to judicious antibiotic use and increasing bacterial resistance. Prompt diagnosis and treatment are imperative to prevent significant morbidity and mortality.
Lemierre syndrome has been called "the forgotten disease," with a reported incidence of around 3.6 cases per million. The mean age at presentation is around 20 years old, though it can occur at any age. Lemierre Syndrome follows an oropharyngeal infection, most commonly pharyngitis, leading to septic thrombophlebitis of the internal jugular vein. is the classic pathogen, though other organisms are being increasingly isolated. Metastatic infections, especially pulmonary, are common complications. Contrast-enhanced CT of the neck confirming internal jugular vein thrombosis is the gold standard for diagnosis. Long-course broad-spectrum IV antibiotics covering anaerobes are the mainstays of the disease's treatment. Anticoagulation may also be considered. Mortality rates are high without treatment, but most patients recover fully with appropriate therapy.
Lemierre syndrome should be suspected in patients with prolonged pharyngitis followed by unilateral neck swelling and fevers. Early diagnosis and prompt antibiotic therapy are key, given the potential for disastrous outcomes if untreated. An increased awareness of Lemierre syndrome facilitates its timely management.
勒米尔综合征是口咽感染的一种罕见且可能致命的并发症，其特征为颈内静脉脓毒性血栓形成。它主要影响健康的青少年和年轻人。抗生素时代后其发病率有所下降，但近几十年来可能有所回升，这可能是由于抗生素的合理使用以及细菌耐药性增加所致。及时诊断和治疗对于预防严重的发病率和死亡率至关重要。
勒米尔综合征被称为“被遗忘的疾病”，报告发病率约为百万分之3.6例。发病时的平均年龄约为20岁，不过任何年龄都可能发生。勒米尔综合征继发于口咽感染，最常见的是咽炎，导致颈内静脉脓毒性血栓形成。虽然其他病原体越来越多地被分离出来，但 是经典病原体。转移性感染，尤其是肺部感染，是常见的并发症。颈部增强CT证实颈内静脉血栓形成是诊断的金标准。覆盖厌氧菌的长疗程广谱静脉用抗生素是该病治疗的主要手段。也可考虑抗凝治疗。未经治疗死亡率很高，但大多数患者经适当治疗可完全康复。
对于咽炎持续时间较长后出现单侧颈部肿胀和发热的患者，应怀疑患有勒米尔综合征。鉴于未经治疗可能产生灾难性后果，早期诊断和及时的抗生素治疗是关键。提高对勒米尔综合征的认识有助于及时进行管理。
