Department of Emergency Medicine, Division of Life Science and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, China.
Departments of Otolaryngology-Head and Neck Surgery, Division of Life Science and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, China.
BMC Infect Dis. 2024 Oct 10;24(1):1137. doi: 10.1186/s12879-024-10033-8.
The co-occurrence of Lemierre's syndrome, primarily triggered by Fusobacterium necrophorum following oropharyngeal infection, with diabetic ketoacidosis (DKA) in diabetes mellitus (DM) patients, underscores a rare but life-threatening clinical scenario. Lemierre's syndrome induced DKA is extremely rare, with only one case report in adult and no case yet reported in elderly.
We reported a case of a 69-year-old female who presented with DKA triggered by deep neck space infection (DNSI), leading to rapid clinical deterioration within 6 h that necessitated high flow nasal cannula (HFNC) and antibiotic administration. Laboratory findings included leukocytosis, elevated serum C-reactive protein, hyperglycemia, ketonemia, and severe metabolic acidosis. Culture of the fluid from a neck mass puncture drainage and blood were positive for Klebsiella pneumoniae. The patient was further complicated by thrombosis of the left internal jugular vein with extension to the sigmoid and a neck abscess surrounding the carotid artery sheath, consistent with Lemierre's syndrome. This condition was managed aggressively with fluid resuscitation, insulin therapy, surgical drainage, antibiotics, and anticoagulation led to a significant improvement in her condition. Following a 13-day hospitalization, there was significant clinical improvement, culminating in the patient's discharge.
The case highlights the need for greater awareness and understanding of the interrelated and mutually promoting conditions of DKA and Lemierre's syndrome among clinicians. Early recognition and treatment are crucial to prevent mortality in such complex cases.
Lemierre 综合征主要由口腔感染后的坏死梭杆菌引起，与糖尿病患者的糖尿病酮症酸中毒（DKA）同时发生，这突显了一种罕见但危及生命的临床情况。糖尿病酮症酸中毒诱发的 Lemierre 综合征极为罕见，仅在成人中报告过一例，且在老年人中尚无报告。
我们报告了一例 69 岁女性病例，因深部颈部间隙感染（DNSI）引发 DKA，导致在 6 小时内迅速临床恶化，需要高流量鼻导管（HFNC）和抗生素治疗。实验室检查结果包括白细胞增多、血清 C 反应蛋白升高、高血糖、酮血症和严重代谢性酸中毒。颈部肿块穿刺引流液和血液培养均为肺炎克雷伯菌阳性。患者还进一步并发左侧颈内静脉血栓形成，延伸至乙状窦和颈动脉鞘周围的颈部脓肿，符合 Lemierre 综合征。通过积极的液体复苏、胰岛素治疗、手术引流、抗生素和抗凝治疗，患者的病情得到了显著改善。经过 13 天的住院治疗，患者的病情明显好转，最终出院。
该病例强调了临床医生需要更好地认识和理解 DKA 和 Lemierre 综合征之间相互关联和相互促进的情况。早期识别和治疗对于预防此类复杂病例的死亡率至关重要。
