Pileflebitis en pediatría: un desafío diagnóstico / Pylephlebitis in pediatrics: A diagnostic challenge

La pileflebitis es definida como la trombosis supurativa de la vena porta como complicación de infecciones abdominales. En pediatría, la etiología más frecuente es la apendicitis, generalmente de diagnóstico tardío, que se presenta como sepsis, con una elevada mortalidad. Para el diagnóstico son necesarios métodos de diagnóstico por imágenes; los más utilizados son la ecografía Doppler y la angiotomografía. El tratamiento se basa en la intervención quirúrgica, la antibioticoterapia y la anticoagulación. Esta última tiene indicación controvertida, pero podría mejorar el pronóstico y disminuir la morbimortalidad. Se presenta un caso clínico de pileflebitis secundaria a sepsis por Escherichia coli con punto de partida en una apendicitis aguda, en un paciente pediátrico que evoluciona a la transformación cavernomatosa de la vena porta. Es de importancia conocer el manejo de esta entidad, ya que, una vez superado el cuadro inicial, requerirá un minucioso seguimiento por la posibilidad de evolucionar a la insuficiencia hepática.

Pylephlebitis is defined as suppurative thrombosis of the portal vein as a complication of abdominal infections. In pediatrics, the most frequent etiology is appendicitis, generally of late diagnosis, presenting as sepsis, with a high mortality rate. Imaging methods are necessary for diagnosis; the most common are the Doppler ultrasound and computed tomography angiography. Treatment is based on surgery, antibiotic therapy, and anticoagulation. The indication for the latter is controversial, but it may improve prognosis and decrease morbidity and mortality. Here we describe a clinical case of pylephlebitis secondary to Escherichia coli sepsis, which started as acute appendicitis in a pediatric patient who progressed to cavernomatous transformation of the portal vein. It is important to know the management of this disease because, once the initial symptoms are overcome, it will require close follow-up due to a potential progression to liver failure.

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.

Superior mesenteric veinous thrombosis with Bacteroides fragilis infection: a case report / 中国热带医学

@#Abstract: Superior mesenteric veinous thrombosis (SMVT) is a rare complication that often occurs in conjunction with intra-abdominal diseases such as diverticulitis, appendicitis, inflammatory bowel disease, etc. Its clinical symptoms are non-specific and include fevers, abdominal pain; it has no specific symptoms, and the diagnosis depends on clinical laboratory tests and imaging studies. The occurrence of superior mesenteric veinous thrombophlebitis is related to septic phlebitis caused by the sloughing of the embolus containing bacteria into the portal vein with blood flow. Due to the nonspecific clinical features of this disease, diagnosing it based on clinical characteristics and microbiological aspects is a challenge. A case of superior mesenteric veinous septic thrombophlebitis caused by Bacteroides fragilis infection is reported and to provide a reference for the diagnosis and treatment of such diseases. The patient was a 34-year-old man who was admitted the hospital with intermittent abdominal pain and fever. Computed tomography (CT) showed partial thrombosis of the superior mesenteric vein, colonoscopy revealed diverticulitis in the ileoceca, and the blood culture grew Bacteroides fragilis. The patient was treated with anti-infection (ceftazidime 2.0 g q12h intravenous infusion for 11 days; metronidazole 0.5 g, q8h intravenous infusion for 3 days) and anticoagulation (rivaroxaban 20 mg qd orally for 8 days. On the 11th day of hospitalization, the patient's condition improved, and he was discharged. In this case, for patients with fever and abdominal pain, superior mesenteric venous thrombophlebitis should be included in the differential diagnosis. Through auxiliary examination, blood sample culture and other technologies, clear diagnosis should be made in time to improve patient outcomes.

Enfermedad de Mondor en un paciente masculino / Mondor disease in a male patient

RESUMEN Introducción: La enfermedad de Mondor es una tromboflebitis superficial que afecta las venas subcutáneas toracoabdominales de forma unilateral, con un pico de incidencia en la quinta década de la vida, afecta de manera especial a las mujeres. Objetivo: Describir la presentación de una tromboflebitis superficial de la vena toracoepigástrica, también llamada enfermedad de Mondor en un varón adulto. Caso clínico: Paciente masculino de 43 años de edad, sin antecedentes relevantes quien acudió a consulta por presentar dolor constante de tres días de evolución localizado en región torácica antero lateral derecha de moderada intensidad no asociado a otra sintomatología. Los hallazgos clínicos destacados durante la exploración abarcaron cifras tensionales elevadas y la presencia de cordón subcutáneo, indurado, que se extiende desde el tercio inferior del cuadrante superior externo de la mama derecha hasta la región subcostal derecha. Se realizó ultrasonografía que reportó ausencia de colapso del vaso estudiado mediante compresión del transductor; se estableció diagnóstico de enfermedad de Mondor y se prescribieron antiinflamatorios no esteroideos durante una semana, con una mejoría gradual de los síntomas y resolución completa a las seis semanas de seguimiento. Conclusiones: Esta enfermedad, a pesar de ser poco frecuente en pacientes masculinos, debe tenerse en cuenta dentro de los diagnósticos diferenciales ante cuadros de dolor o induración longitudinal superficial en pared anterolateral del tórax, aun en ausencia de factores de riesgo para su aparición, el uso de la ultrasonografía corresponde a una buena herramienta diagnóstica complementaria para llegar al diagnóstico.

ABSTRACT Introduction: Mondor's disease is a superficial thrombophlebitis that affects the thoracoabdominal subcutaneous veins mainly unilaterally, with a peak incidence in the fifth decade of life affecting mainly women. Objective: To describe the presentation of a superficial thrombophlebitis of the thoracoepigastric vein, also called Mondor's disease, in a male adult. Case report: A 43-year-old male patient with no relevant history who consulted for presenting constant pain of three days of evolution located in the right anterolateral thoracic region of moderate intensity not associated with other symptoms. The clinical findings highlighted during the examination include elevated blood pressure levels and the presence of an indurated subcutaneous cord that extends from the lower third of the upper outer quadrant of the right breast to the right subcostal region. Ultrasonography is performed, which reports the absence of collapse of the vessel studied by compression of the transducer. A diagnosis of Mondor's disease is established and non-steroidal anti-inflammatory drugs are prescribed for one week, with gradual improvement in symptoms and complete resolution at six weeks of follow-up. Conclusions: This disease, despite being a rare entity, especially in male patients, should be taken into account within the differential diagnoses of pain or superficial longitudinal induration in the anterolateral chest wall, even in the absence of risk factors for its appearance, the use of ultrasonography corresponds to a good complementary diagnostic tool to reach the diagnosis.

Analysis of drug therapy in a patient with pulmonary infection secondary to suppurative thrombophlebitis / 药学实践杂志

Objective To explore the role of pharmaceutical care in the treatment of patients with pulmonary infection secondary to suppurative thrombophlebitis. Methods The treatment of a patient diagnosed with pulmonary metastatic infection secondary to suppurative thrombophlebitis and the whole process of clinical pharmacists participating in the monitoring were analyzed retrospectively. The use of antibiotics was evaluated, and the experience of coagulation management in suppurative thrombophlebitis was explored. Results Based on the infection site, characteristics of septic thrombus, monitoring of vancomycin blood concentration, pharmacokinetics and pharmacodynamics characteristics of antibiotics, clinical pharmacists provided comprehensive pharmaceutical services for clinicians and patients in terms of anti-infection scheme adjustment, optimization of vancomycin individualized treatment, anticoagulant timing. Patient’s systemic infection and septic thrombus can be effectively controlled and which promotes the treatment of patients with suppurative thrombophlebitis. Conclusion Clinical pharmacists can play an important role in the treatment team of severe patients to improve the rational use of antibiotics.

Enfermedad de Mondor del pene en un paciente joven / Mondor disease of the penis in a young patient

Se presenta el caso clínico de un paciente de 21 años de edad, con antecedente de herniorrafia inguinal derecha, quien asistió a consulta de control y refirió presentar una induración y dolor en la región dorsal del pene con 4 días de evolución, que había comenzado después de una relación sexual en la cual consumió marihuana. En el examen físico se encontró la vena dorsal del pene engrosada, dura y dolorosa a la palpación. Se le diagnosticó una enfermedad de Mondor del pene. La ecografía Doppler confirmó la tromboflebitis de esta vena. El paciente recibió tratamiento médico y evolucionó satisfactoriamente.

The case report of a 21 years patient with history of right inguinal herniorrhaphy is presented, who attended control visit and he made reference to an induration and pain in the dorsal region of the penis with 4 days of evolution that had begun after a sexual relationship in which he consumed marihuana. In the physical exam the penis dorsal vein was found thicken, hard and painful to the palpation. He was diagnosed a Mondor disease of the penis. The Doppler scanning confirmed the thrombophlebitis of this vein. The patient received medical treatment and had a favorable clinical course.

Embolismo séptico en paciente con Síndrome de Lemierre / Septic embolism in a patient with Lemierre's Syndrome

RESUMEN Introducción: el síndrome de Lemierre, describe a la flebotrombosis séptica de la vena yugular interna posterior a una infección orofaríngea. Esta enfermedad representa un verdadero reto diagnóstico para el médico practicante. Las complicaciones más temidas son las relacionadas con la embolización a distancia. Objetivo: describir la evolución clínica de una paciente con síndrome de Lemierre atendida en el Hospital Militar Central "Dr. Carlos J. Finlay". Caso Clínico: paciente femenina de 24 años de edad, con antecedentes de salud; 12 días antes del ingreso comenzó con fiebre de 39-40˚C, asociada a odinofagia y secreciones blanquecinas localizadas sobre ambas amígdalas. Tras recibir antibioticoterapia por vía oral percibe discreta mejoría. Luego de la cual recrudece la fiebre, aparece tos, disnea y dolor en punta de costado en el hemitórax derecho. Conclusiones: la evolución de la paciente fue satisfactoria luego del drenaje quirúrgico de la colección pleural, el uso de antibióticos específicos y la anticoagulación. La atención de pacientes con síndrome de Lemierre requiere asistencia especializada.

ABSTRACT Introduction: Lemierre's Syndrome (LS) describes septic phlebothrombosis of the internal jugular vein following oropharyngeal infection. This entity represents a real diagnostic challenge for the practicing physician. The most alarming complications are those related to distant embolization. Objective: to describe the clinical evolution of a patient with Lemierre's Syndrome treated at Dr. Carlos J. Finlay Central Military Hospital. Case Report: a 24-year-old female patient with a medical history; who 12 days before admission started with fever of 39-40˚C, associated with odynophagia and whitish secretions located over both tonsils. After receiving oral antibiotic therapy, she perceived a slight improvement. Subsequently fever intensified, cough, dyspnea and flank pain in the right hemithorax appear. Conclusions: the evolution of the patient was satisfactory after surgical drainage of the pleural collection, the use of specific antibiotics and anticoagulation. The care of patients with Lemierre's syndrome requires specialized assistance.

Enfermedad de Mondor y mamoplastías / Mondor's disease and mammoplasty

Resumen Objetivo: Revisar la incidencia de esta enfermedad en pacientes sometidos a mamoplastías en una clínicaprivada en el período de 11 años, con el fin de describir sus síntomas y signos, diagnóstico, tratamiento y evolución. Materiales y Método: Se estudiaron 355 mujeres que se sometieron a mamoplastías estéticas. Se excluyó aquellas cirugías reconstructivas secundarias a cáncer de mama y aquellas con otros antecedentes oncológicos previos. La información fue recolectada de las fichas clínicas. Resultado: Se analizan 710 mamas operadas en el período 2008-2018, de las cuales seis mamas (6/710) evolucionaron con enfermedad de Mondor (0,8%). El diagnóstico se realizó clínicamente. Todos los casos recibieron terapia antiinflamatoria oral y local, respondiendo favorablemente. Discusión: Existe poca literatura publicada al respecto. Casos bilaterales son menos reportados. Pareciera asociarse con cirugías del surco submamario y no está claro que requiera curación terapéutica. Conclusiones: La enfermedad de Mondor es infrecuente, puede presentarse secundario a mamoplastías, es de diagnóstico clínico y sólo tratamiento sintomático con evolución satisfactoria sin secuelas.

Aim: Review the disease incidence in patients who had mammoplasties in a private clinic on a 11 year-period. The purpose is to describe their symptoms and signs, diagnosis, treatment and evolution. Materials and Method: 355 women who underwent cosmetic mammoplasties were studied. Those reconstructive surgeries secondary to breast cancer and those with other previous oncological history were excluded. The information was collected from clinical files. Results: 710 breasts operated between 2008-2018 are analyzed, six of them (6/710) evolved Mondor disease (0.8%). The diagnosis was made clinically. All cases received oral and local antiinflammatory therapy, responding favorably. Discussion: There is a few published literature about it. Bilateral cases are less reported. It appears to be associated with surgeries of the submammary sulcus and it is not clear that it requires therapeutic cure. Conclusions: Mondor's disease is infrequent, can occur secondary to mammoplasty, diagnosis is clinical, treatment is symptomatic, all cases had satisfactory evolution without sequelae.

Tromboembolismo pulmonar decorrente de tromboflebites venosas superficiais em membros superiores pós-cirurgia plástica mamária estética: relato de 3 casos / Pulmonary thromboembolism due to superficial venous thrombophlebitis in upper limbs after cosmetic breast plastic surgery: report of 3 cases

Tromboses e tromboflebites superficiais de membros superiores são doenças frequentes e muitas vezes pouco valorizadas. Relatamos três pacientes no pós-operatório de cirurgias plásticas mamárias estéticas que apresentaram tromboflebite em membros superiores e que evoluíram com tromboembolismo pulmonar. Todas as pacientes apresentaram quadro clínico típico, com comprovação pelo Doppler ultrassonografia de trombose/flebite superficial de membros superiores e ausência de lesões em membros inferiores, bem como aumento de dímero-D e comprovação da embolia pulmonar por tomografia computadorizada ou cintilografia pulmonar. Os três casos evoluíram com melhora após anticoagulação e sem sequelas.

Superficial thrombosis and thrombophlebitis of the upper limbs are frequent and often underestimated diseases. We report three patients in the postoperative cosmetic breast plastic surgery period who presented thrombophlebitis in the upper limbs and who evolved with pulmonary thromboembolism. All patients had a typical clinical picture, with Doppler ultrasound evidence of thrombosis/superficial phlebitis of the upper limbs and absence of lesions in the lower limbs and an increase in D-dimer and evidence of pulmonary embolism by computed tomography or pulmonary scintigraphy. The three cases evolved with improvement after anticoagulation and without sequelae.

Trends on management of superficial venous disease

Venous disease is more common in the society but less addressed than peripheral arterial disease. This is commonest in people who are sedentary workers, people standing for prolonged period, obase. Usually this group of people do not visit a doctor until it restricts him from regular work, ultimately causing a burden in the community. Early diagnosis of venous disease and its’ management is important. Understanding venous pathology, educating people about disease, conducting awareness program among target group of people are essential. Superficial venous disease includes both venous insufficiency and venous thrombosis. Management options of varicose vein and thrombophlebitis are discussed in the presentation.

Enfermedad de Mondor: A propósito de un caso clínico / Clinical Case Report: Mondor's Disease

La enfermedad de Mondor es una entidad clínica caracterizada por la aparición de una induración palpable similar a un cordón en la superficie del cuerpo. En general es considerada como una tromboflebitis benigna autolimitada que se resuelve en cuatro u ocho semanas sin ningún tratamiento específico. Se presenta un caso de aparición súbita y evolución favorable, espontánea. Se realiza una revisión de la literatura a propósito del mismo.

Mondor's disease is a clinical entity characterized by the appearance of a palpable cord-like lesion on the surface of the body. It is generally considered self-limiting benign thrombophlebitis that resolves in four to eight weeks without any specific treatment. It presents in the case of sudden appearance and favorable, spontaneous evolution. A literature review on the subject is carried out.

Efficacy of Topical Heparin in Prevention of Superficial Thrombophlebitis before Peripheral Venous Cannulation.

Thrombophlebitis can be very commonly associated with peripheral venous cannulation. Many a times, thrombophlebitis may go undiagnosed. With serious complications and uncertainty of the treatment, it is always better to prevent its development. Prophylactic topical heparin application can significantly reduce the incidence of thrombophlebitis and also the complications related like deep venous thrombosis and pulmonary embolism which increase the hospital stay. Thus, this study was conducted to evaluate the efficacy of topical heparin in prevention of development of superficial thrombophlebitis.METHODS150 patients in the age group of 20 - 60 years, were randomly allocated to group H (Heparin), group C (Control), with 75 patients in each group. Group C received placebo (normal saline) and group H received topical heparin QPS before the insertion of the cannula on the dorsum of the upper limb and were observed at an interval of 8 hours until 72 hours using Visual Infusion Phlebitis Scale.RESULTSAt the end of 72 hours, score of 0, I, II, and III was observed in 5.33%, 44.00%, 29.33% and 21.33% patients, respectively, in Group C; whereas score of 0, I, and II was observed in 60%, 25.33%, and 14.67% patients, respectively in Group H (P = 0.0001). In Group C, score up to III was observed, whereas maximum score was II in Group H and that too at 72 h in only 14.67% of patients which proves the efficacy of topical QPS of heparin [Table 2].CONCLUSIONSProphylactic topical application of QPS heparin was effective in preventing development of superficial thrombophlebitis.

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.

Post-injection thrombophlebitis in patients undergoing peripheral IV catheterization in a tertiary care hospital: incidence and risk factors

Background:Intravenous catheters cause endothelial damage and trauma, which can predispose to venous thrombosis. Peripheral vein infusion thrombophlebitis occurs in 25-35% of hospitalized patients with intravenous catheters and has both patient-related implications (e.g., sepsis) and economic consequences (e.g., extra nursing time). This study is designed to address this issue, by assessing the potential risk factors in those who have developed phlebitis, and deriving conclusions based on the same.Methods:A total of 830 patients were observed over a period of 2 months. All details of the patient were collected. Thrombophlebitis was graded using visual infusion phlebitis score. Each case was compared with a matching control.Results:53 of 830 patients observed, developed thrombophlebitis giving an incidence of 6.4%. 92.5% had IV cannulation flushed after insertion. IV cannula had to be changed at least 2 times during the hospital stay. All had an average IV cannulation for 5 days. All had insertion of same size cannula (20G). Level 1 Phlebitis was identified in 64.15% patients, level 2 Phlebitis in 33.96% patients and Level 3 Phlebitis was seen 1.88% patients.Conclusions:Significant association was noted between the number of times the catheter was changed since admission and administration of Potassium chloride and Certain Medications such as Piperacillin through the cannula

Flegmasia cerulea dolens. Reporte de casos / Phlegmasia cerulea dolens. Cases report

Resumen La flegmasia cerulea dolens (FCD, flebitis, cianosis, dolor) es una complicación rara de la trombosis venosa profunda, se debe a obstrucción del retorno venoso, generalmente del miembro inferior, con cianosis severa y compromiso circulatorio que compromete vasos colaterales, a diferencia de la flegmasía alba dolens que no compromete las colaterales. El cuadro clínico se caracteriza por dolor de inicio súbito, debido al aumento significativo de la presión venosa, que lleva a ausencia de pulsos periféricos y gangrena. Pocas veces se presenta en la práctica médica diaria, por lo que el diagnóstico es importante para evitar la gangrena. Se presentan tres casos de pacientes atendidos. Se confirmó el diagnóstico clínico y por imágenes, se muestra la evolución y el tratamiento médico realizado.

Summary Phlegmasia cerulea dolens (phlebitis, cyanosis, pain) is a rare severe form of deep venous thrombosis, caused by obstruction of the vein flow of the lower limb (usually) with severe cyanosis and circulatory compromise which affects collateral vessels, unlike Phlegmasia alba dolens not compromise collateral vessels. It is characterized by sudden onset of pain, because an increase of the venous pressure, that can lead to pulselessness and gangrene. Is unfrequently in daily medical practice, so the diagnosis is important to avoid gangrene. We present three cases of patients attended with this disease. Diagnosis was confirmed by clinic and imaging; we present the evolution and medical treatment that was performed.

Deep venous thrombosis induced by intravenous thrombogenic drugs

Background: Deep vein thrombosis (DVT) is a major preventable cause of morbidity and mortality worldwide with the potential to cause a dreaded pulmonary embolism (PE). Disease and patient-specific considerations are preferably incorporated into therapeutic options for effective management. Materials and methods: Sixty-eight cases of acute deep vein thrombosis were treated within a period of 3 years from January 2016. All the cases were subjected to routine investigations with the Doppler study of the affected limb. Low molecular weight heparin (dalteparin) was administered in all the cases for a period of 15 days and the Doppler study was repeated at the end of the drug therapy. After the course of low molecular weight heparin, the patients were given acenocoumarol 2mg daily. Estimation of partial thromboplastin time and prothrombin time were performed before starting and during the treatment of the low molecular weight heparin and acenocoumarol regularly. A venogram was done only when the repeated Doppler study revealed unsatisfactory response to low molecular weight heparin therapy. Eight cases underwent thrombectomy and the postoperative period was uneventful. Results: Age group of 21-30 years was most affected (80.8%) with right lower limb being the commonest affected site of injection and associated lesions. Conclusion: DVT in the young population remains a challenge to the evaluating clinician. A variety of disease states can alter the anticoagulant factors. Urgent diagnosis and appropriate intervention carry paramount importance.

Acometimento pulmonar e articular secundário à síndrome de Lemierre: relato de caso e revisão de literatura / Pulmonary and joint involvement secondary to Lemierre syndrome: case report and literature review

A síndrome de Lemierre caracteriza-se por uma rara entidade que gera tromboflebite da veia jugular interna e embolismo séptico em história da infecção recente da orofaringe, além de sinais radiológicos e isolamento de patógenos anaeróbicos, principalmente Fusobacterium necrophorum. Relatamos o caso de uma paciente do sexo feminino, 13 anos de idade, com histórico de carcinoma de nasofaringe associado ao vírus Epstein-Barr (estadiamento T4N2M0), submetida a procedimentos cirúrgicos e quimiorradioterapia. Iniciou com queixa de mialgia intensa, diplopia, lesões infectadas em membros e choque séptico. Por meio de exames de ultrassonografia cervical com Doppler colorido e tomografia computadorizada de pescoço com contraste endovenoso, foram identificados trombos intraluminais na veia jugular interna, além de trombos sépticos pulmonares, por meio da tomografia computadorizada de tórax. Posteriormente, ainda evoluiu com artrite piogênica coxofemoral esquerda. Foi isolada, por hemocultura, a bactéria Klebsiella pneumoniae Carpemenase, e o tratamento se deu pela associação entre vancomicina, amicacina, meropenem, metronidazol e anfotericina B. Conclui-se que, após o diagnóstico de SL e, embora com múltiplas complicações e diagnóstico tardio, a paciente encontra-se bem e assintomática, além do relato comprovar a dificuldade diagnóstica e de seu tratamento

Lemierre's syndrome is a rare condition that leads to thrombophlebitis of the internal jugular vein and septic embolism following recent oropharyngeal infection, being characterized by radiological signs and isolation of anaerobic pathogens, especially Fusobacterium necrophorum. We report the case of a 13-year-old female patient with history of nasopharyngeal carcinoma associated with Epstein-Barr virus (T4N2M0 staging), who underwent surgical procedures and chemoradiotherapy. Her initial complaint was severe myalgia, diplopia, infected limb injuries, and septic shock. Cervical color Doppler ultrasound and computed tomography scan of the neck with intravenous contrast showed intraluminal thrombi in the internal jugular vein, and chest computed tomography showed pulmonary septic thrombi. Subsequently, she progressed with left coxofemoral pyogenic arthritis. The bacterium Klebsiella pneumoniae Carpemenase was isolated in blood culture, and the patient was treated with the association of vancomycin, amikacin, meropenem, metronidazole, and amphotericin B. It is concluded that, despite the multiple complications and late diagnosis, the patient is well and asymptomatic after the diagnosis of Lemierre's syndrome; in addition, the report proves the difficulty of diagnosis and treatme

Síndrome de Lemierre. Caso y revisión de la literatura / Lemierre's syndrome. Clinical case and literature review / Síndrome de Lemierre. Caso clínico e revisão da literatura

Resumen: El síndrome de Lemierre constituye una entidad poco frecuente y potencialmente grave que puede complicar una infección orofaríngea. Incluye una tromboflebitis de la vena yugular interna y embolias sépticas a distancia. Presentamos el caso clínico de un hombre joven que se presentó, luego de una infección respiratoria alta, con una trombosis de vena yugular interna, seno sigmoideo y transverso izquierdos, asociando además tromboembolismo pulmonar séptico y empiema pleural. Mostró buena evolución con antibioticoterapia empírica, drenaje pleural y anticoagulación. Realizamos una revisión de la literatura sobre este tema enfatizando los aspectos clínicos, epidemiológicos y microbiológicos.

Summary: Lemierre's syndrome constitutes a rare and potentially serious entity, that may complicate oropharyngeal infections. This condition includes thrombophlebitis of the internal jugular vein and distant septic embolisms. The study presents the clinical case of a young man who consulted after an upper respiratory infection, with internal jugular vein thrombosis, left sigmoid and transverse seins, also associating septic pulmonary embolism and pleural empyema. The patient had a positive evolution after empirical antibiotic, pleural drainage and anticoagulants. We conducted literature review on this condition, focusing on clinical, epidemiological and microbiological aspects.

Resumo: A síndrome de Lemierre é uma doença rara e potencialmente grave que pode complicar uma infecção orofaríngea. Inclui uma tromboflebite da veia jugular interna e embolias sépticas a distância. Descrevemos o caso clínico de um homem jovem que depois de uma infecção respiratória alta apresentou trombose de veia jugular interna, seio sigmoide e transverso esquerdos, associado com tromboembolismo pulmonar séptico e empiema pleural. Teve boa evolução com antibioticoterapia empírica, drenagem pleural e anticoagulação. Realizamos uma revisão da literatura sobre este tema enfatizando os aspectos clínicos, epidemiológicos e microbiológicos.

Rare complications of Staphylococcus aureus infection in children: Case reports / Complicaciones infrecuentes de infección por Staphylococcus aureus en niños: reporte de casos

Abstract Disseminated staphylococcal disease comprises a set of clinical manifestations secondary to multiple organ invasion that may range from cellulitis to sepsis. In pediatrics, the most common complications are osteoarticular and cutaneous infection; however, this article presents rare manifestations such as glomerulonephritis and thrombotic phenomena. This is the report of two cases of previously healthy adolescents: one presented with osteomyelitis and kidney injury, and the other, with lower limb cellulitis and respiratory deterioration with septic pulmonary embolism. The diagnostic process and additional management are described, highlighting the role of oxacillin in therapy. This article aims to highlight the importance of considering the rare manifestations of S. aureus infection, when the clinical evolution is abnormal, in order to initiate a timely treatment and get a better prognosis.

Resumen La enfermedad diseminada por Staphylococcus aureus comprende un conjunto de manifestaciones clínicas secundarias a su invasión multiorgánica que van desde celulitis hasta sepsis. En pediatría, las complicaciones más comunes son las infecciones osteoarticular y cutánea; sin embargo, este artículo presenta algunas manifestaciones poco frecuentes, tales como la glomerulonefritis y los fenómenos trombóticos. Se presentan dos casos de pacientes adolescentes previamente sanos: el primero cursó con osteomielitis y lesión renal, y el segundo, con celulitis de miembro inferior, deterioro respiratorio y embolismo pulmonar séptico documentado. Se describe el proceso diagnóstico y manejos adicionales, y se resalta el papel de la oxacilina en la terapia. Este artículo pretende destacar la importancia de considerar las manifestaciones infrecuentes de la infección por S. aureus cuando la evolución clínica sea anormal para instaurar el tratamiento oportuno y propender por un mejor pronóstico.

Síndrome de Lemierre simulando síndrome paraneoplásico: reporte de un caso y revisión de la literatura / Lemierre syndrome simulating signs and symptoms of paraneoplastic syndrome: case report and literature review

El síndrome de Lemierre es una enfermedad rara, ocasionada por la complicación grave de una infección orofaringea que se manifiesta con una tromboflebitis séptica en la yugular interna y una embolización séptica a distancia. En principio, el síndrome cursa con fiebre, dolor en el área del ángulo de la mandíbula, inflamación de la región periamigdalina y un crecimiento unilateral del cuello luego de una infección en las estructuras de la cabeza y el cuello. En el artículo se presenta el caso de una mujer de 45 años quien consultó por una complicación infecciosa posterior a la realización de una exodoncia. El diagnóstico clínico se realizó con base en los signos y síntomas que indicaban tromboflebitis séptica del seno cavernoso. Se realiza antibióticoterapia con resultados positivos en la paciente y, como resultado, una mejoría total del estado de salud. Se presenta este caso por lo infrecuente de la entidad.

Lemierre syndrome is a disease caused by the serious complication of an oropharyngeal infection that manifests with septic thrombophlebitis in internal jugular and remote septic embolization. It presents with fever, pain in the area of the jaw angle, inflammation of the peritonsillar region and unilateral neck growth after an infection in the head and neck structures. We present the case of a 45-year-old woman who consulted due to an infectious complication after carrying out the extraction. The clinical diagnosis was made based on the signs and symptoms that indicated septic thrombophlebitis of the cavernous sinus. Antibiotic therapy is performed with positive results in the patient and total improvement of the state of health.