Lemierre syndrome: case report

Abstract Lemierre syndrome is characterized by septic thrombophlebitis of the internal jugular vein, after an oropharyngeal infection, with septic embolization to the lungs or other organs. This case report describes a 37-year-old female patient who presented with edema and pain in the right hemiface with onset 3 days previously and progressive fatigue and dyspnea since the previous day. She had had tooth 48 extracted 3 days previously. Physical examination at admission found tachypnea, with 60% saturation (in room air), edema at the angle of the right mandible, diffuse reduction of vesicular murmur, and calves free from clubbing. Angiotomography of the chest and laboratory tests were compatible with septic emboli, and cervical computed tomography confirmed a diagnosis of septic thrombophlebitis of the internal jugular vein. She was managed with antibiotics and given treatment for her symptoms. Lemierre syndrome most often occurs in young men and there is embolization to the lungs in up to 97% of cases. Rarely, the etiology of this syndrome may be tooth extraction. Computed tomography is the imaging method most often used for diagnosis and treatment is basically antibiotic. Surgery is thus rarely necessary.

摘要 莱姆耶雷综合征（Lemierre syndrome）以口咽部感染后继发颈内静脉化脓性血栓性静脉炎，并伴肺部或其他器官化脓性栓塞为主要临床特征。本病例报告介绍1例37岁女性患者，该患者3天前出现右侧半面部水肿与疼痛，次日起出现进行性乏力与呼吸困难。患者于3天前拔除了48号牙（tooth 48）。入院体格检查示呼吸急促，室内空气下血氧饱和度为60%，右侧下颌角可见水肿，肺泡呼吸音弥漫性减弱，双下肢无杵状指。胸部血管造影计算机断层扫描（CT）及实验室检查结果符合化脓性栓塞表现，颈部计算机断层扫描（CT）确诊为颈内静脉化脓性血栓性静脉炎。患者接受抗生素治疗及对症支持处理。莱姆耶雷综合征多见于青年男性，多达97%的病例会出现肺部栓塞。该综合征的极少数病因可由拔牙引发。计算机断层扫描是目前最常用的诊断影像学手段，治疗以抗生素为主，手术干预极为罕见。