Lemierre's Syndrome, a Forgotten Disease: Case Report and Review of the Literature

Lemierre氏症候群：病例報告與文獻回顧

賴君宇(Chun-Yu Lai) ； 葉育雯(Yu-Wung Yeh) ； 林鎮均(Chen-Chun Lin)

《胸腔醫學》 25卷1期 (2010/02) Pp. 31-37

https://doi.org/10.29806/TM.201002.0006

摘要

Lemierre氏症候群，一個古老，罕見，但卻有潛在性致命危險的疾病，主要是由厭氧菌壞死細梭桿菌造成口咽部的感染，進而侵犯到內頸靜脈造成栓塞性靜脈炎，最後經由血行性傳染造成全身性轉移的敗血症（主要是以肺部的表現為主），我們報告一個29歲的健康男性，在兩週的上呼吸道感染症狀之後，於短短的時間內就進展到呼吸衰竭與急性呼吸窘迫症候群，一開始所有檢體的染色都顯示是革蘭氏陰性桿菌，但只有在厭氧瓶的血液培養中有細菌生長，在有了初步方向與Lemierre氏症候群的診斷，選用適當的抗生素治療之後，病人情況開始改善，但是接下來的的胸部X光片顯示敗血性栓塞與膿胸的形成，胸部電腦斷層也有同樣的發現，除此之外，還發現病人的內頸靜脈有血管內的栓塞，雖然病人在臨床上並沒有脖子腫痛的症狀，在外科引流膿胸與持續的抗生素治療之後，病人成功的脫離呼吸器，於幾天後健康的出院。
因為抗生素的發明以及廣泛的被使用，Lemierre氏症候群的發生率的確有下降的趨勢，但最近不斷的宣導上呼吸道感染不應例行性的使用抗生素之後，這個被遺忘的疾病有病例增加的趨勢，使用正確的抗生素治療決定此疾病的預後，含有乙型內醯胺酶抑制劑的盤尼西林維治療的首選，對於合併有脖子腫脹，上呼吸道症狀與肺部病變的病人，鑑別診斷時應該把此疾病列入考慮。

關鍵字

Lemierre氏症候群 ； 肺炎 ； 上呼吸道感染 ； 血栓性靜脈炎 ； 壞死細梭桿菌

並列摘要

Lemierre's syndrome is an ancient and rare disorder with a fatal potential. It is an infection usually caused by the anaerobe Fusobacterium necrophorum and spreads from the oropharynx to the thrombosed internal jugular vein, eventually resulting in sepsis via the hematogenous route. We report a healthy 29-year-old male who developed acute respiratory distress syndrome (ARDS) after an upper respiratory tract infection 2 weeks previous. The initial Gram stains all showed Gram-negative rods, which only grew in anaerobic blood culture bottles. After the diagnosis of Lemierre's syndrome was made and the antibiotic regimen adjusted accordingly, the patient began to improve. However, subsequent chest radiographs showed septic emboli and empyema; chest computed tomography (CT) supported the diagnosis and confirmed the presence of internal jugular vein thrombi. After chest tube drainage in addition to continued antibiotic treatment, the patient was successfully weaned off the mechanical ventilator and discharged from the hospital.
After the introduction of antibiotics, the incidence rate of Lemierre's syndrome decreased. With the appearance of drug-resistant bacteria associated with the overuse of antibiotics, however, general practitioners are now discouraged from prescribing antibiotics for uncomplicated upper respiratory tract infections. With the changes made in the antibiotics prescribing pattern, the incidence rate of this almost forgotten disease seems to be on the rise again. Correct and timely antibiotics usage improves the prognosis of Lemierre's syndrome. Beta-lactamase-containing penicillins are the drugs of choice. Lemierre's syndrome should remain in the differential diagnoses when treating patients with pneumonia preceded by upper respiratory tract infection and neck fullness or discomfort.

並列關鍵字

Lemierre's syndrome ； pneumonia ； upper respiratory tract infection ； thrombophlebitis ； Fusobacterium necrophorum