- 期刊
Lemierre Syndrome Presenting with Septic Pulmonary Embolism and Diffuse Vesiculopustular Skin Rashes: A Case Report
Lemierre症候群以敗血性肺栓塞和全身性皮膚膿泡疹來表現：一病例報告
摘要
Lemierre症候群通常是由於口咽部的厭氧菌感染，進而併發內頸靜脈血栓靜脈炎和栓塞性轉移感染。栓塞性轉移感染最常見的部位是肺部，其它還包括了關節、軟組織及中樞神經系統。在過去的文獻中，菌血性轉移感染至皮膚是不常見的。我們提出一年輕男性病例以喉嚨痛為初期表現，進而出現發燒、頸部疼痛及全身的皮膚膿泡疹。其頭部的電腦斷層攝影發現右側咽喉旁膿瘍及外頸靜脈血栓。住院過程中併發敗血性休克及急性呼吸衰竭。從病人的血液培養中分離出壞死細梭桿菌。我們以抗生素加上手術引流和摘除外頸靜脈血栓成功地治療這位病患。雖然Lemierre症候群的治療主要以具對抗厭氧性細菌的抗生素為主，但是對於難以控制的感染和反覆的敗血性肺栓塞，摘除頸靜脈血栓的手術治療可能有其必要性。
並列摘要
Lemierre syndrome is usually an anaerobic infection of the oropharyngeal space, followed by septic thrombophlebitis of the internal jugular vein and metastatic infections by septic embolization. The most common site of metastatic infection is the lungs, as well as other sites, including the joints, soft tissue and central nervous system. Skin involvement is a less common presentation as a consequence of continuous bacteremia, according to the previous literature. We describe a young man with the initial presentation of sore throat, and who subsequently developed fever, neck pain and generalized skin vesiculopustular rashes. Neck computed tomography (CT) scans demonstrated right parapharyngeal abscess and thrombosis of the external jugular vein. Hospitalization was complicated with septic shock and acute hypoxic respiratory failure. Fusobacterium necrophorum was isolated from the blood culture. Successful treatment was achieved by intravenous antibiotics with surgical drainage for the deep neck infection and the ligation/excision of external jugular vein thrombosis. Although the main treatment for Lemierre syndrome is intravenous antibiotics with good anti-anaerobic activity, surgical debridement, as well as ligation and excision of the thrombosed jugular vein, may be necessary for uncontrolled infection and repeated septic embolization.
延伸閱讀
- Wong, K. S., Chen, H. W., Yan, D. C., & Lin, T. Y. (1998). 黴漿菌性肺炎續發Swyer James症候群：一病例報告. Acta Paediatrica Sinica, 39(4), 271-273. https://doi.org/10.7097/APS.199808.0271
- Huang, Y. C., Lin, C. Y., Hung, C. Y., & Huang, C. C. (2018). 單純皰疹病毒支氣管肺炎於免疫力健全病人引起的口腔黏膜皰疹性潰瘍及支氣管炎合併急性呼吸性窘迫：病例報告. 胸腔醫學, 33(3), 117-122. https://www.airitilibrary.com/Article/Detail?DocID=10239855-201806-201805240003-201805240003-117-122
- Su, W. L., Chen, C. W., Tsai, C. L., Wu, M. C., Soh, L. H., & Wu, C. P. (2004). 次發性修格蘭症候群併發多發性肺囊腫及淋巴性間質性肺炎－一病例報告及文獻回顧. 胸腔醫學, 19(6), 509-516. https://doi.org/10.29806/TM.200412.0012
- Tsai, K. D., Hang, L. W., Cheng, W. E., & Hsia, T. C. (2002). 以支氣管擴張症和反復肺部感染表現的Good's症候群：一病例報告. 胸腔醫學, 17(2), 182-186. https://www.airitilibrary.com/Article/Detail?DocID=10239855-200206-17-2-182-186-a
- Wang, C. J., Chen, P. J., Peng, M. J., Chen, T. L., Sheu, C. Y., Liu, H. C., & Wang, T. (2001). 索格倫氏症候群及類澱粉樣沉積病併有肺部大泡形成：病例報告. 胸腔醫學, 16(2), 129-135. https://www.airitilibrary.com/Article/Detail?DocID=10239855-200106-16-2-129-135-a