Anticoagulación en paciente con síndrome de Lemierre y embolias sépticas pulmonares / Anticoagulation in a patient with Lemierre syndrome and pulmonary septic embolisms

Resumen El síndrome de Lemierre, también denominado trom boflebitis séptica de la vena yugular interna, necrobaci losis o sepsis postanginal es una infección que inicia en el espacio orofaríngeo, se complica con tromboflebitis séptica de la vena yugular interna y metástasis infeccio sas. La rápida progresión a cuadros clínicos graves que comprometen la vida del paciente y su baja frecuencia justifican la divulgación de casos clínicos. Se presenta el caso de una mujer de 27 años de edad, que a las 48 horas de completar el tratamiento con fenoximetilpenicilina por una infección odontógena evolucionó con edema facial y trismus. En la angio-TC de macizo craneofacial se evidenció extenso trombo en la vena yugular interna y en la tomografía computarizada de tórax, embolias sépticas pulmonares. El tratamiento consistió en antibió ticos endovenosos de amplio espectro y anticoagulación de manera precoz.

Abstract Lemierre's syndrome, also called septic thrombo phlebitis of the internal jugular vein, necrobacillosis or postanginal sepsis, is an infection that begins in the oropharyngeal space, is complicated by septic throm bophlebitis of the internal jugular vein and infectious metastases. The rapid progression to serious clinical conditions that compromise the patient's life and its low frequency justify the disclosure of clinical cases. We present the case of a 27-year-old woman who de veloped facial edema and trismus 48 hours after com pleting treatment with phenoxymethylpenicillin for an odontogenic infection. An angio-CT of the craniofacial massif revealed an extensive thrombus in the internal jugular vein and a computed tomography of the chest showed septic pulmonary emboli. Treatment consisted of broad-spectrum intravenous antibiotics and early anticoagulation.

Tromboflebitis séptica pelviana post cesárea / Septic pelvic thromboflebitis after cesarean section

RESUMEN Presentamos caso clínico de puérpera de cesárea de noveno día con cuadro febril en espigas, asintomática, en que se plantea desde su ingreso el diagnóstico de tromboflebitis séptica pelviana y se inicia tratamiento con antibióticos parenterales de amplio espectro y heparina de bajo peso molecular en dosis terapéuticas. La respuesta es a la mejoría al tercer día de tratamiento. Se discuten los métodos diagnósticos, el diagnóstico diferencial y el tratamiento.

ABSTRACT A case of a woman on her 9th post-operative day after childbirth by cesarean section (CS) consulting with febrile spikes, otherwise asymptomatic, is presented. The diagnosis of a septic pelvic thrombophlebitis is proposed from the admission and treated with parenteral broad-spectrum antibiotics and low-molecular-weight heparin at therapeutic doses. Patient significantly improved on her third day of treatment. The diagnostic procedures, differential diagnosis and treatment are discussed.

Disseminated staphylococcal infection in an immunocompetent adult: A case report

@#<p style="text-align: justify;">Septic pulmonary embolism is an uncommon disorder in which septic thrombi are mobilized from an infectious nidus and transported in the vascular system of the lungs. We report a case of a 52-year-old immunocompetent female who suffered from septic pulmonary embolism associated with polymyositis, deep venous thrombosis and pericardial effusion. Oxacillin-sensitive staphylococcus aureus (MSSA) was isolated from her sputum. Clinical presentation improved after incision of the muscle abscess and vancomycin treatment.</p>

Pileflebitis: Un desafío diagnóstico / Pylephlebitis: Diagnostic challenge

RESUMEN: La pileflebitis es la tromboflebitis séptica de la vena porta y/o de sus ramas, que suele presentarse de manera aguda y generalmente como complicación de procesos inflamatorios intraabdominales. La clínica es inespecífica. El diagnóstico es clínico e imagenológico. El objetivo de este trabajo es revisar la patogenia de esta entidad y sus modos de presentación clínica y radiológica a través del análisis de un caso clínico. Enfatizamos la importancia del diagnóstico temprano que permite su tratamiento dirigido y eficaz.

ABSTRACT: Pylephlebitis is thrombophlebitis of the portal vein and/ or of its branches; it is acute and generally arises as a complication of inflammatory intra-abdominal processes. The clinical is non-specific. The diagnosis is clinical and radiological. The aims of this study are to review the pathophysiology of this entity and its clinical and radiological presentation through the a clinical case. We wish to emphasize tha importance of early diagnosis, which make it possible to establish an efficient treatment.

Detection of an Infected N-butyl-2-cyanoacrylate Plug by F-18 FDG PET/CT Scan in a Patient Who Received Endoscopic Intervention for Gastric Variceal Bleeding

Injection of N-butyl-2-cyanoacrylate has been used successfully for treatment of gastric variceal bleeding. Bacteremia after injection of N-butyl-2-cyanoacrylate is well known, however, the method for diagnosis of infected endovascular injected material has remained uncertain. This is the first case reporting use of F-18 FDG PET/CT in detection of the source of infection after control of endoscopic bleeding with N-butyl-2-cyanoacrylate.

Lemierre Syndrome

Lemierre syndrome is an uncommon disease which commonly arise from acute bacterial oropharyngeal infection. This disease was first described in 1900 by Courmont and Cade Lemierre. It is commonly caused by Fusobacterium necrophorum1. Lemierre syndrome has been reported to be serious and potentially fatal in the preantibiotic era1. It is characterized by an oropharyngeal infection leading to secondary septic thrombophlebitis of the internal jugular vein with embolization to the lungs and other organs. The incidence has become relatively rare at present and is usually only diagnosed when unsuspected culture results are available1. We report a case of Lemierre syndrome which was recently diagnosed in our centre.

Tromboflebite séptica em paciente imunossuprimida: relato de caso / Septic thrombophlebitis in an immunosuppressed patient: case report

JUSTIFICATIVA E OBJETIVOS: Choque séptico e síndrome de falência múltipla de órgãos e sistemas continuam a representar importante causa de morbimortalidade nos pacientes oncológicos submetidos à tratamento. O objetivo deste estudo foi apresentar um caso de sepse grave por estafilococos aureus em paciente imunossuprimida portadora de infecção vascular do tipotromboflebite séptica. RELATO DO CASO: Paciente do sexo feminino, 68 anos, com quadro clínico de febre, tromboflebite séptica no membro superior direito, bacteremia com múltiplas hemoculturas positivas para estafilococo aureus, fibrilação atrial aguda com resposta ventricular elevada e neutropenia grave. Possuía antecedente de adenocarcinoma ductal primário da mama já tratado e de linfoma não-Hodgkin abdominal sob quimioterapia contínua nos últimos 10 anos. CONCLUSÃO: Este relato ressalta a dificuldade no tratamento da sepse por estafilococo aureus decorrente de tromboflebite em paciente com imunossupressão conhecida.

BACKGROUND AND OBJECTIVES: Septic shock and multiorganic failure syndrome seem to represent an important causeof morbidity and mortality for the treated oncologic patients.The main objective of this study is to report a case of severe staphylococcal sepsis in a patient with immunosupression and vascular infection due to septic thrombophlebitis. CASE REPORT: Female patient, sixty-eight years-old, presenting with fever, septic thrombophlebitis in her right upper limb, bacteremiawith multiple hemocultures with identification of staphylococcus aureus, acute atrial fibrillation with elevated ventricular rateand severe neutropenia. There was a medical past of a previously treated breast primary ductal adenocarcinoma many years ago and a present abdominal non- Hodgkin lymphoma under continuous chemotherapeutic management in the last ten years. CONCLUSION: The authors call attention for the difficulty in the treatment of sepsis originated from staphylococcal thrombophlebitis infection in an immunosupressed patient.

A hematogenic pleuropneumonia caused by postoperative septic thrombophlebitis in a Thoroughbred gelding

A 7-year-old Thoroughbred gelding was admitted to Equine Hospital, Korea Racing Association for evaluation and treatment of colic. Based on the size and duration of the large colonic and cecal impaction, a routine ventral midline celiotomy and large colon enterotomy were performed to relieve the impaction. Six days following surgery the gelding exhibited signs of lethargy, fever, inappetence and diarrhea. Eleven days following surgery, the jugular veins showed a marked thrombophlebitis. On the sixteenth day of hospitalization the gelding died suddenly. Upon physical examination, the horse was febrile, tachycardic and tachypnoeic. Thoracic excursion appeared to be increased; however, no abnormal lung sounds were detected. No cough or nasal discharge was present. Hematology revealed neutrophilic leukocytosis. Serum biochemistry was normal but plasma fibrinogen increased. In necropsy, fibrinopurulent fluid was present in the thoracic cavity. There were firm adhesions between visceral pleura and thoracic wall. White, mixed and red thrombi were formed in both jugular veins from the insertion point of IV catheter. Histopathological examination showed fibrinopurulent inflammation and vascular thrombosis in the lung. The pleura showed edematous thickening and severe congestion. The clinicopathological and pathological findings suggest that septic thrombi associated with septic thrombophlebitis metastasized into the pulmonary circulation and were entrapped in the pulmonary parenchyma and provoked pleuropneumonia.