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一例由化脓性链球菌引起的勒米尔综合征罕见病例。

A Rare Case of Lemierre's Syndrome Caused by Streptococcus pyogenes.

作者信息

Fontoura Mário G, Araujo Rita P, Paupério Ana G, Costa Rita Q, Teixeira Mónica

机构信息

Internal Medicine Department, Unidade Local de Saúde Entre Douro e Vouga, Santa Maria da Feira, PRT.

出版信息

Cureus. 2024 Dec 16;16(12):e75823. doi: 10.7759/cureus.75823. eCollection 2024 Dec.

DOI:10.7759/cureus.75823
PMID:39822432
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11735246/
Abstract

Lemierre's syndrome (LS) is a rare condition characterized by septic thrombophlebitis of the internal jugular vein (IJV). Typically, the primary infection originates in the oropharynx, progressing to the lateral pharyngeal space, IJV, and potentially leading to bacteremia. Through septic embolization, these patients can develop severe complications, underscoring the importance of early diagnosis. We present a case of LS in a 33-year-old female who initially presented to the emergency department with odynophagia and was diagnosed with acute tonsillitis. She was discharged with antibiotics. However, one week later, she returned with sudden-onset dyspnea. After a comprehensive workup during her hospital stay, an LS caused by was diagnosed. The patient was treated with anticoagulation and antibiotics, resulting in a favorable clinical outcome. This case highlights the importance of maintaining a high level of clinical suspicion for LS in the differential diagnosis of complicated tonsillitis, emphasizing the critical role of early identification and appropriate management. Additionally, we aim to review the pathophysiology, management strategies, and current literature on LS, offering insights into the clinical approach to these rare yet potentially fatal cases.

摘要

勒米尔综合征(LS)是一种罕见疾病,其特征为颈内静脉(IJV)发生感染性血栓性静脉炎。通常,原发性感染起源于口咽部,进而发展至咽旁间隙、颈内静脉,并可能导致菌血症。通过感染性栓子形成,这些患者可能会出现严重并发症,这凸显了早期诊断的重要性。我们报告一例33岁女性的勒米尔综合征病例,该患者最初因吞咽痛就诊于急诊科,被诊断为急性扁桃体炎。她接受抗生素治疗后出院。然而,一周后,她因突发呼吸困难再次就诊。在住院期间进行全面检查后,诊断为由 引起的勒米尔综合征。该患者接受抗凝和抗生素治疗,临床结局良好。本病例强调在复杂扁桃体炎的鉴别诊断中对勒米尔综合征保持高度临床怀疑的重要性,突出早期识别和适当管理的关键作用。此外,我们旨在回顾勒米尔综合征的病理生理学、管理策略和当前文献,为这些罕见但可能致命的病例的临床处理提供见解。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8248/11735246/c43d4a0b969f/cureus-0016-00000075823-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8248/11735246/c43d4a0b969f/cureus-0016-00000075823-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8248/11735246/c43d4a0b969f/cureus-0016-00000075823-i01.jpg

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本文引用的文献

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Joint Guideline on Venous Thromboembolism - 2022.《静脉血栓栓塞症联合指南 - 2022》
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Early Diagnosis and Antibiotic Treatment Combined with Multicomponent Hemodynamic Support for Addressing a Severe Case of Lemierre's Syndrome.早期诊断、抗生素治疗联合多组分血流动力学支持治疗1例严重的勒米尔综合征
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莱姆病相关性血栓形成、血栓性静脉炎和莱姆病(BATTLE)注册研究的现状:证据和原理。
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Lemierre's syndrome in adulthood, a case report and systematic review.成人莱姆病综合征:病例报告及系统评价
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J Vasc Surg Cases Innov Tech. 2020 Feb 4;6(1):31-33. doi: 10.1016/j.jvscit.2019.11.007. eCollection 2020 Mar.
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Antibiotic and Anticoagulation Therapy in Lemierre's Syndrome: Case Report and Review.勒米尔综合征中的抗生素与抗凝治疗:病例报告及综述
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Lemierre Syndrome: Clinical Update and Protocol for a Systematic Review and Individual Patient Data Meta-analysis.勒米埃综合征:临床更新及系统评价和个体患者数据荟萃分析方案。
Hamostaseologie. 2019 Feb;39(1):76-86. doi: 10.1055/s-0038-1654720. Epub 2018 Aug 2.
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Lemierre's Syndrome: A Neglected Disease with Classical Features.勒米尔综合征:一种具有典型特征的被忽视疾病。
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