Muranaka Emiri, Kurasawa Kanta, Matsuda Naoya, Kimeda Chiharu, Mannoji Chikato, Hase Ryota
Department of Infectious Diseases, Japanese Red Cross Narita Hospital, Narita, Japan.
Department of Infectious Diseases, Japanese Red Cross Narita Hospital, Narita, Japan; Department of Infectious Diseases, Kameda Medical Center, Kamogawa, Japan.
J Infect Chemother. 2025 Aug 7;31(10):102785. doi: 10.1016/j.jiac.2025.102785.
Lemierre syndrome, traditionally defined as septic thrombophlebitis of the internal jugular vein following an oropharyngeal infection, is most commonly caused by Fusobacterium necrophorum. We report an unusual variant of this syndrome in a 29-year-old male who presented with F. necrophorum bacteremia following tonsillar infection, complicated by vertebral osteomyelitis of the T10 vertebral body, azygos vein thrombosis, and septic pulmonary emboli (infected emboli that lodge in the lungs). The patient developed severe thrombocytopenia, consistent with the thrombogenic properties of F. necrophorum. Initial treatment with intravenous cefepime and metronidazole was administered, followed by ampicillin-sulbactam, and subsequently switched to oral clindamycin due to a drug eruption. The patient completed a 12-month course of antibiotics with full clinical recovery and no evidence of relapse at 20-month follow-up after treatment completion. While the classical definition of Lemierre syndrome focuses on internal jugular vein involvement, our case supports a broader conceptualization that encompasses septic thrombophlebitis at various vascular sites. This atypical presentation highlights the importance of thorough radiological evaluation in patients with persistent oropharyngeal symptoms and unexpected systemic manifestations, even when the classic internal jugular vein thrombosis is absent. The unique combination of thoracic vertebral osteomyelitis and azygos vein thrombosis represents an extremely rare manifestation with significant implications for diagnosis and management.
勒米尔综合征，传统上定义为口咽感染后颈内静脉的化脓性血栓性静脉炎，最常见的病因是坏死梭杆菌。我们报告了一名29岁男性患者的该综合征不寻常变体，该患者扁桃体感染后出现坏死梭杆菌菌血症，并并发T10椎体的椎骨骨髓炎、奇静脉血栓形成和脓毒性肺栓塞（栓子滞留在肺部并感染）。患者出现严重血小板减少症，这与坏死梭杆菌的致血栓形成特性相符。最初给予静脉注射头孢吡肟和甲硝唑治疗，随后使用氨苄西林-舒巴坦，之后因药物疹改用口服克林霉素。患者完成了12个月的抗生素疗程，临床完全康复，治疗结束后20个月随访无复发迹象。虽然勒米尔综合征的经典定义侧重于颈内静脉受累，但我们的病例支持更广泛的概念，即包括不同血管部位的化脓性血栓性静脉炎。这种非典型表现突出了对有持续口咽症状和意外全身表现的患者进行全面影像学评估的重要性，即使不存在经典的颈内静脉血栓形成。胸椎骨髓炎和奇静脉血栓形成的独特组合代表了一种极其罕见的表现，对诊断和管理具有重要意义。
