PDF(Pubmed)
Abstract：
Lemierre-like syndrome is a rare, systemic sequelae following a persistent oropharyngeal infection, leading to septic thrombophlebitis of the internal jugular vein (IJV). Lemierre syndrome is caused by the obligate anaerobic organism Fusobacterium necrophorum, innate to the oropharyngeal tract. Lemierre-like syndrome is due to infections caused by other organisms, including methicillin-resistant Staphylococcus aureus (MRSA). We are reporting a case of a five-month-old male who presented with one week of fever that was not alleviated by acetaminophen, bilateral otitis media, and left-sided cervical lymphadenopathy not alleviated with medical therapy. The patient\'s clinical course continued to deteriorate as he developed respiratory distress that progressed to acute respiratory failure requiring mechanical ventilation support. Extensive laboratory investigation ruled out the causes of primary and secondary immunodeficiencies. Blood cultures were positive for MRSA, and he was treated initially with vancomycin, then switched to linezolid per ENT recommendations, and ultimately needed daptomycin and ceftaroline therapy. A computed tomography (CT) scan of the neck and chest showed deep neck space infection, bilateral loculated pleural empyema, and mediastinitis. The patient required a decortication video-assisted thoracoscopic surgery (VATS), multiple drains, and a mediastinal washout to control the MRSA infection. This report emphasizes that the rapid progression and spread of septic thrombus can become detrimental to a patient\'s recovery and survival; therefore, it should be recognized early and treated promptly.
摘要：
Lemierre样综合征是一种罕见的,持续口咽感染后的全身后遗症，导致颈内静脉化脓性血栓性静脉炎（IJV）。Lemierre综合征是由专性厌氧菌坏死梭菌引起的，与生俱来的口咽道。Lemierre样综合征是由于其他生物引起的感染，包括耐甲氧西林金黄色葡萄球菌（MRSA）。我们正在报告一例5个月大的男性发烧一周，对乙酰氨基酚没有缓解，双侧中耳炎,左侧颈部淋巴结肿大未通过药物治疗缓解。患者的临床病程继续恶化，因为他出现了呼吸窘迫，发展为需要机械通气支持的急性呼吸衰竭。广泛的实验室调查排除了原发性和继发性免疫缺陷的原因。血培养物MRSA阳性,他最初是用万古霉素治疗的，然后根据ENT建议改用利奈唑胺，最终需要达托霉素和头孢洛林治疗。颈部和胸部的计算机断层扫描（CT）扫描显示深颈部空间感染，双侧局限性胸膜脓胸，和纵隔炎.患者需要进行电视胸腔镜手术（VATS），多个排水沟,和纵隔冲洗以控制MRSA感染。本报告强调，化脓性血栓的快速进展和扩散可能对患者的康复和生存产生不利影响；因此，应及早发现并迅速治疗。
