[Lemierre syndrome due to Porphyromonas spp. in a 21 year-old patient]

Síndrome de Lemierre: relato de caso

A síndrome de Lemierre é uma doença rara, mais comum em jovens, causada frequentemente pelo Fusobacterium necrophorum. Inicia-se com faringite e propaga-se até a veia jugular interna, promovendo uma fonte de bacteremia contínua e êmbolos sépticos pulmonares. Manifestações clínicas incluem febre, alterações respiratórias e massa cervical. O diagnóstico é realizado por tomografia computadorizada e duplex scan, além de hemocultura ou cultura direta. O tratamento é realizado com antibióticos beta-lactâmicos resistentes a beta-lactamases, sendo a cirurgia raramente necessária. Paciente do sexo feminino, 34 anos, com quadro de orofaringite, evoluiu em 48 horas com queda do estado geral, febre, aumento de volume e dor em região cervical esquerda. Radiografia e tomografia de tórax evidenciaram múltiplas lesões pulmonares. A tomografia cervical e o duplex scan confirmaram a trombose da veia jugular interna, compatível com tromboflebite supurativa aguda, a síndrome de Lemierre. Após antibioticoterapia, o paciente apresentou melhora do quadro clínico. O duplex scan de controle evidenciou recanalização venosa.

Lemierre’s Syndrome Complicating Bacterial Pharyngitis in a Patient With Undiagnosed Factor XII Deficiency

Internal jugular vein thrombosis occurs as an uncommon complication of oropharyngitis. The following case report describes a previously healthy adult woman who presented with sore throat, left ear pain, and fever. She was initially diagnosed with pharyngitis and inadvertently had blood cultures sent as part of her workup. She was then called back to the Emergency Department the following day for positive growth of the blood culture, and found to have thrombophlebitis of the internal jugular vein on computed tomography scan of the neck. Further workup revealed factor XII deficiency. The clinical course was further complicated by septic pulmonary emboli and disseminated intravascular coagulation. The patient was treated with broad-spectrum antibiotics and anticoagulation and made a full recovery.

[Lemierre's syndrome: a report of six cases]

OBJECTIVE

Lemierre's syndrome is a rare but severe condition combining pyrexia, cervical pain and pulmonary signs following a pharyngeal infection, usually tonsillitis. This infectious disease is still present in our country despite wide use of antibiotic therapy in pharyngeal infections.

METHODS

In a retrospective study conducted between 1995 and 2000 in two departments (infectious diseases and critical care unit) of Nice university hospital (Nice, France), we collected and analysed six cases of Lemierre's syndrome.

RESULTS

We describe a serie of 6 cases, all of them female patients of mean age 27. We enrolled healthy patients whose initial symptom was tonsillitis. Most of these patients showed signs of severe sepsis and one died of septic shock. All the others recovered with treatment. The mean time between tonsillitis and first sign of sepsis was seven days. In four cases, patients received a beta- lactam antimicrobial agent with metronidazole. In two cases, patients were treated with amoxicillin-clavulanate. All patients were investigated for the presence of internal jugular vein thrombosis and were treated by anticoagulants when research was positive.

CONCLUSIONS

A strong presumptive diagnosis can be made on the basis of clinical presentation, secondarily confirmed by para-clinical data. The prognosis depends on the speed and quality of management. We therefore wished to raise awareness of this condition among our colleagues by reporting our personal experience.