Zhou Yimeng, Zhai Yongzhen, Wang Yan, Zhang Dan, Feng Guohe
Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang, China.
Front Med (Lausanne). 2024 Aug 14;11:1402444. doi: 10.3389/fmed.2024.1402444. eCollection 2024.
Lemierre's syndrome is a rare and serious complication of pharyngitis with an estimated annual incidence of 1 in 100,000 people worldwide. It is characterized by septic thrombophlebitis of the internal jugular vein with metastatic infection, usually after oropharyngeal infection. Rare cases of Lemierre's syndrome have been reported to be caused by odontogenic infection.
A 33-year-old male visited our hospital with symptoms of fever and sore throat for 16 days. The other symptoms included pain in his left neck and shoulder. In addition, metabolic syndrome was diagnosed based on waist circumference, diabetes, and hyperlipidemia. bacteria was detected using the metagenomic next-generation sequencing (mNGS) technique. The enhanced computerized tomography (CT) scan showed thrombosis of the left proximal jugular vein and brachiocephalic vein. Based on these observations, Lemierre's syndrome was diagnosed. The etiology was that the fillings in the root canal tooth were lost with no blood or pain about 2 weeks before the onset. The patient recovered after treatment with antibiotics and blood purification.
Lemierre's syndrome should be evaluated for patients with fever, sore throat, and neck pain. If the loss of fillings from root canal therapy occurs, especially for those with metabolic syndrome, we should be aware of the possibility of this disease. Furthermore, the mNGS test can be used as a crucial supplementary diagnostic tool for patients with undetermined fever.
勒米尔综合征是咽炎的一种罕见且严重的并发症，全球估计年发病率为十万分之一。其特征为颈内静脉脓毒性血栓形成并伴有转移性感染，通常发生在口咽感染之后。据报道，罕见的勒米尔综合征病例由牙源性感染引起。
一名33岁男性因发热和咽痛症状持续16天前来我院就诊。其他症状包括左颈部和肩部疼痛。此外，根据腰围、糖尿病和高脂血症诊断为代谢综合征。使用宏基因组下一代测序（mNGS）技术检测到细菌。增强计算机断层扫描（CT）显示左颈近端静脉和头臂静脉血栓形成。基于这些观察结果，诊断为勒米尔综合征。病因是根管治疗的补牙材料在发病前约2周脱落，无出血或疼痛。患者经抗生素和血液净化治疗后康复。
对于发热、咽痛和颈部疼痛的患者应评估是否患有勒米尔综合征。如果根管治疗的补牙材料脱落，特别是对于那些患有代谢综合征的患者，我们应意识到患此病的可能性。此外，mNGS检测可作为不明原因发热患者的关键辅助诊断工具。
