PDF(Pubmed)
Abstract：
BACKGROUND: Lemierre-like syndrome (LLS) is characterized by bacteremia, septic thrombophlebitis of the internal jugular vein, and metastatic abscesses. In contrast to classic Lemierre syndrome, sources of infection are not related to oropharyngeal infections, as are frequent soft tissue infections. In recent years, Staphylococcus aureus has been identified as an emergent pathogen that causes this syndrome. The mortality rate of LLS caused by this pathogen is approximately 16%. Timely diagnosis, antibiotic treatment, and infection control are the cornerstones to treat LLS. Anticoagulant therapy as adjuvant treatment remains controversial.
METHODS: A 31-year-old woman from California, United States (US), was admitted to the emergency room with a history of 2 days of fever and severe throbbing pain in the left cervical region. Thorax and neck CT tomography revealed confluent cavities suggestive of septic embolism in the lungs and a filiform thrombus in the lumen of the left internal jugular vein, with moderate swelling of the soft and muscular tissues. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from the blood culture.
METHODS: The thrombus in the internal jugular vein associated with cellulitis in the neck and multiple cavitary lesions in the lungs support the diagnosis of LLS caused by MRSA with septic embolization.
METHODS: During treatment, the patient received vancomycin IV for 25 days and returned to the US with linezolid orally. In addition, assisted video-thoracoscopy and bilateral mini-thoracotomy with pleural decortication were performed for infectious source control, where 1700cc of purulent pleural fluid was drained.
RESULTS: The patient was discharged with optimal evolution.
CONCLUSIONS: LLS should be suspected in patients with skin and soft tissue infections who develop thrombosis or metastatic infections. MRSA infections should be considered in patients from areas where this pathogen is prevalent.
METHODS: A 31-year-old woman from California, United States (US), was admitted to the emergency room with a history of 2 days of fever and severe throbbing pain in the left cervical region. Thorax and neck CT tomography revealed confluent cavities suggestive of septic embolism in the lungs and a filiform thrombus in the lumen of the left internal jugular vein, with moderate swelling of the soft and muscular tissues. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from the blood culture.
METHODS: The thrombus in the internal jugular vein associated with cellulitis in the neck and multiple cavitary lesions in the lungs support the diagnosis of LLS caused by MRSA with septic embolization.
METHODS: During treatment, the patient received vancomycin IV for 25 days and returned to the US with linezolid orally. In addition, assisted video-thoracoscopy and bilateral mini-thoracotomy with pleural decortication were performed for infectious source control, where 1700cc of purulent pleural fluid was drained.
RESULTS: The patient was discharged with optimal evolution.
CONCLUSIONS: LLS should be suspected in patients with skin and soft tissue infections who develop thrombosis or metastatic infections. MRSA infections should be considered in patients from areas where this pathogen is prevalent.
摘要：
背景：Lemierre样综合征（LLS）的特征是菌血症，颈内静脉化脓性血栓性静脉炎，和转移性脓肿.与经典的Lemierre综合征相反,感染源与口咽感染无关，常见的软组织感染也是如此。近年来,金黄色葡萄球菌已被确定为引起该综合征的新兴病原体。由这种病原体引起的LLS的死亡率约为16％。及时诊断,抗生素治疗,和感染控制是治疗LLS的基石。抗凝治疗作为辅助治疗仍存在争议。
方法：一位来自加州的31岁女性，美国(US),入院急诊室，有2天的发烧和左颈部严重的搏动疼痛的历史。胸部和颈部CT断层扫描显示融合腔，提示肺部有感染性栓塞，左颈内静脉腔有丝状血栓，软组织和肌肉组织中度肿胀。从血培养物中分离出耐甲氧西林金黄色葡萄球菌(MRSA)。
方法：颈内静脉血栓伴颈部蜂窝织炎和肺部多发空洞性病变支持MRSA伴感染性栓塞引起的LLS的诊断。
方法：治疗期间，患者接受万古霉素IV治疗25天,并口服利奈唑胺返回美国.此外,辅助电视胸腔镜和双侧小切口胸膜剥脱术用于感染源控制，排出1700cc化脓性胸膜液。
结果：患者以最佳进展出院。
结论：发生血栓形成或转移性感染的皮肤和软组织感染患者应怀疑LLS。MRSA感染应考虑在该病原体流行地区的患者中。
方法：一位来自加州的31岁女性，美国(US),入院急诊室，有2天的发烧和左颈部严重的搏动疼痛的历史。胸部和颈部CT断层扫描显示融合腔，提示肺部有感染性栓塞，左颈内静脉腔有丝状血栓，软组织和肌肉组织中度肿胀。从血培养物中分离出耐甲氧西林金黄色葡萄球菌(MRSA)。
方法：颈内静脉血栓伴颈部蜂窝织炎和肺部多发空洞性病变支持MRSA伴感染性栓塞引起的LLS的诊断。
方法：治疗期间，患者接受万古霉素IV治疗25天,并口服利奈唑胺返回美国.此外,辅助电视胸腔镜和双侧小切口胸膜剥脱术用于感染源控制，排出1700cc化脓性胸膜液。
结果：患者以最佳进展出院。
结论：发生血栓形成或转移性感染的皮肤和软组织感染患者应怀疑LLS。MRSA感染应考虑在该病原体流行地区的患者中。
