Lemierre症候群の1例 - jrs.or.jp

1 41 9 2003 651.. Lemierre 1 .. 30 . X . CT CT . septic emboli Lemierre CLDM CFPM .. Lemierre . Septic emboli -Streptoccous haemolytic, Fusobacterium necrophorum Table 1 Laboratory data on admission . Hematology Serology Lemierre WBC 12,500 / l CRP mg/dl Neu % IgM mg/dl Lymph % IgG 1,630 mg/dl . Eos % IgA 407 mg/dl septic emboli Le- Mono % C3 121 mg/dl mierre 1 Baso % C4 mg/dl RBC 299 104/ l CH50 U/ml Hb g/dl ANA negative Plt 104 / l anti-DNA 2 . 30 Biochemistry RA negative g/dl anti-RNP negative T. Bil mg/dl anti-Sm negative 10 23 . GOT 17 IU/l immune complex g/ml 13 2 11 GPT 23 IU/l anti-CL IgG LDH 222 mg/dl anti-CL IgM 2 14.

2 ALP 181 mg/dl lupus anticoagulant PAPM! BP -GTP 29 IU/l protein C 69 %. BS 149 mg/dl protein S 127 %.. T-chol 90 mg/dl PR3-ANCA 10 EU. PAPM! BP BUN mg/dl MPO-ANCA 10 EU. X Cr mg/dl endotoxin pg/ml Na 134 mEq/l B-D-glucan pg/ml 2 21 . K mEq/l Sputum culture negative 157 cm 48 kg Cl 101 mEq/l Blood culture negative 154! 72 mmHg 100! Blood gas analysis pH PCO2 torr coarse crackles . PO2 torr 116 8567 2 1 10. 2 . 15 1 6 . 652 41 9 2003 . Fig. 1 Chest radiograph showing an infiltrative shadow with cavity in the right lower field and right pleural effusion.

3 Fig. 2 CT scan of thorax showing multiple pulmonary Table 1 .. cavitary nodules in both lung fields and pleural effu- l CRP mg! 13,400! dl . sion on the right side. 104! l . l CRP mg! 12,500! dl . dl FDP g! fibrinogen 487 mg! ml . C S .. Streptococcus haemolytic 5 . X Fig. 1 .. CT Fig. 2 4 cm . 1 2 cm . CT Fig. 3 .. Fig. 4 . Fig. 3 Contrast-enhanced CT scan of the neck demon- septic em- strating thrombosis of the left internal jugular vein. bolism Lemierre . a-Streptoccous haemolytic . 5 a- CFPM 4 g! CLDM 1,200 mg! . Streptoccous haemolytic.

4 CLDM 3 PAPA! BP X 40. CLDM Lemierre CT .. CFPM . Lemierre 1 653. Fig. 4 Clinical course.. 6 metastatic abscess .. 15 4 . Lemierre 1 10 10 metastatic ab- scess . metastatic abscess . 1 2 . 1900 Courmont 1 Lemierre . 1936 Lemierre3 metastatic abscess . Lemierre .. 4 5 Lemierre F. necrophorum . 8 . 1 Fusobacterium necrophorum F. necrophorum . 4 . F. necrophorum .. 5 8 . forgotten disease 4 .. 6 . 8 . a-Streptoccous haemo- metastatic abscess lytic 5 . Lemierre a-Streptoccous 95 4 9 haemolytic 4 11 . Lemierre F. necrophorum Lemierre F. necrophorum.

5 654 41 9 2003 . drome : two cases of a forgotten disease. J Oral Max- Lemierre illofac Surg 1994 ; 52 : 74 78. 6 Screaton N, Ravenel J, Lehner P, et al : Lemierre syndrome : Forgotten but not extinct-report of four cases. Radiology 1999 ; 213 : 369 374. 145 . 7 Koay C, Heyworth T, Burden P : Lemierre syn- 2000 7 . drome a forgotten complication of acute tonsillitis. J Laryugol Otol 1995 ; 109 : 657 669. 8 Lemierre 1 Stallworth J, Carroll J : Lemieere'. s syndrome : new Fusobacterium necroforum . insights into an old disease. Clin Pediatrics 1997 ; 36 : 1 1994 ; 32 : 1083 1087.

6 715 718. 9 Williams A, Nagy M, Wingate J, et al : Lemieere syn- 2 Courmont P, Cade A : Sur une septicopyohemie de drome : a complication of acute pharyngitis. Int J Pe- I'. homme simulant la peste et causee par un strep- diatr Otorhinolaryngol 1998 ; 45 : 51 57. tovacille anaerobie. Arch Med Exp Anat Pathol 10 Moreno S, Altozano JG, Pinilla B, et al : Lemierre's 1900 ; No. 4 disease : postanginal bacteraemia and pulmonary in- 3 Lemierre A : On certain septicaemias due to anaero- volvement by Fusobacterium necrophorum. Rev In- bic organisms.

7 Lancet 1936 28 : 701 703. fect Dis 1989 ; 11 : 319 324. 4 Sinave P, Hardy J, Fardy W, et al : Lemierre syn- 11 Hagelskj!r L, Prag J, Malczynski J, et al : Incidence drome : suppurative thrombophlebitis of the inter- and clinical epidemiology of necrobacillosis includ- nal jugular vein secondary to oropharyngeal infec- ing Lemierre'. s syndrome, in Denmark 1990 1995. tion. Medicine 1989 ; 68 : 85 94. Eur J Clin Microbiol Infect Dis 1998 ; 17 : 561 565. 5 Carlson E, Bergamo D, Coccia C : Lemierre'. s syn- Abstract A case of Lemierre syndrome Mitsutoshi Hayashi, Isao Yamawaki, Junko Nakata, Noriko Watanabe and Shin-ichiro Ohkawa Department of Internal Medicine, Tokyo Women'.

8 S Medical University Daini Hospital, 2 1 10 Nishiogu, Arakawa-ku, Tokyo, Japan, 116 8567. We present a case of Lemierre syndrome characterized by thrombophlebitis of the internal jugular vein with multiple metastatic foci after acute otopharyngeal infection in a 30-year-old woman. Despite treatment with tonsil- lectomy leading to a diagnosis of peritonsillar abscess, her condition worsened and she was admitted with high fe- ver. Chest radiograph and CT scan of the thorax revealed multiple pulmonary cavities and pleural effusion on the right side.

9 On neck CT, a thrombus was detected in the left internal jugular vein. She received with intravenous clindamycin CLDM and cefepime CFPM and progressively improved. Although Lemierre syndrome is a rela- tively uncommon disease with the potentially life-threatening complication of acute pharyngotonsillitis, this syn- drome should be considered in cases of severe tonsillitis or pharyngitis.