ABSTRACT
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
Subject(s)
Humans , Female , Adolescent , Pulmonary Embolism/etiology , Arthritis, Infectious/etiology , Lemierre Syndrome/complications , Hip Joint/microbiology , Klebsiella pneumoniae/isolation & purification , Antiviral Agents/therapeutic use , Pleural Effusion/diagnostic imaging , Pulmonary Embolism/diagnostic imaging , Neck Dissection , Synovitis/diagnostic imaging , Arthritis, Infectious/diagnostic imaging , Tomography, X-Ray Computed , Nasopharyngeal Neoplasms/virology , Herpesvirus 4, Human/isolation & purification , Ultrasonography, Doppler, Color , Rare Diseases/complications , Diagnosis, Differential , Delayed Diagnosis , Lemierre Syndrome/diagnosis , Lemierre Syndrome/microbiology , Lemierre Syndrome/blood , Lemierre Syndrome/virology , Blood Culture , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic useSubject(s)
Humans , Male , Adolescent , Brain Abscess/diagnosis , Cholesteatoma, Middle Ear/diagnosis , Labyrinthitis/diagnosis , Lemierre Syndrome/diagnosis , Mastoiditis/diagnosis , Otitis Media, Suppurative/complications , Otitis Media, Suppurative/diagnosis , Otitis Media, Suppurative/drug therapy , Anti-Bacterial Agents/therapeutic use , Diagnosis, DifferentialABSTRACT
Descrita pela primeira vez em 1900 por Coumont e Cade, a tromboflebite séptica da veia jugular interna (síndrome de Lemierre) é uma condição rara. Acomete indivíduos jovens e possui elevada morbimortalidade. Relatamos o caso de uma paciente atendida inicialmente como portadora de amigdalite bacteriana e que retornou com piora do quadro, associado à trombose da veia jugular interna, evoluindo, na internação, com embolia séptica pulmonar. Além de relatar o caso, fazemos breve revisão da literatura e chamamos a atenção sobre este importante assunto.(AU)
First described in 1900 by Coumont and Cade, septic thrombophlebitis of the internal jugular vein (Lemierre's syndrome) is relatively rare. It affects young patients and has high morbidity and mortality. We describe the case of a woman first diagnosed with a bacterial tonsillitis, who returned to the hospital with worsening of the condition, associated with internal jugular vein thrombophlebitis, that developed to pulmonary embolism during her hospitalization. We reported the case, and made a brief review of the literature, highlighting the details of this important condition.(AU)
Subject(s)
Humans , Female , Adult , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic use , Jugular Veins/pathology , Lemierre Syndrome/diagnosis , Lemierre Syndrome/drug therapy , Pulmonary EmbolismABSTRACT
El síndrome de Lemierre (SL) es una emergencia diagnóstica y requiere una terapéutica urgente. Se define como una tromboflebitis séptica de la vena yugular interna (VYI) secundaria a una infección orofaríngea. En la mayoría de los casos el germen implicado es el Fusobacterium necrophorum (FN). Afecta tanto al adulto joven como al adolescente pero muy poco al niño. Esta rara afección debe beneficiarse de un diagnóstico precoz. En el caso contrario, se acompaña con un riesgo elevado de mortalidad. Les exponemos en este trabajo, el caso de una niña de 6 años con un SL tras una otitis media aguda asociada a manifestaciones cutáneas de la septicemia. La paciente mejoró bajo una combinación de antibióticos (8 semanas) y anticoagulantes (3 meses).
Lemierre’s syndrome is a rare, acute and severe entity It is characterized by thrombosis of the internal jugular vein and metastatic infections especially lung localization. The main pathogen is Fusobacterium necrophorum. This pathology concerns rarely the child. Early diagnosis is crucial otherwise the mortality will increase. We report of Lemierre’s syndrome in a girl of 6 years old with favourable outcome. Antibiotherapy targeting anaerobes has been rapidly Introduced and maintained 8 weeks. The anticoagulation has been maintained 3 months.
Subject(s)
Humans , Female , Child , Lemierre Syndrome/diagnosis , Lemierre Syndrome/drug therapy , Fusobacterium necrophorum , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic useABSTRACT
A tromboflebite supurativa da veia jugular interna ou síndrome de Lemierre foi descrita pela primeira vez em 1900. O evento inicial mais frequente é a infecção de orofaringe associada à trombose da veia jugular interna. Embora uma entidade rara, a síndrome de Lemierre continua a ser uma doença de morbidade e mortalidade consideráveis devido à sua progressão e atrasos de diagnóstico.
Suppurative thrombophlebitis of the internal jugular vein, or Lemierre syndrome, was described for the first time in 1900. The most common initial event is an infection of the oropharynx associated with thrombosis of the internal jugular vein. While it is a rare entity, Lemierre syndrome remains a disease that causes considerable morbidity and mortality, due to its progression and to delays in diagnosis.