Síndrome de Lemierre: relato de caso

Abstract

Lemierre syndrome is characterized by septic thrombophlebitis of the internal jugular vein, after an oropharyngeal infection, with septic embolization to the lungs or other organs. This case report describes a 37-year-old female patient who presented with edema and pain in the right hemiface with onset 3 days previously and progressive fatigue and dyspnea since the previous day. She had had tooth 48 extracted 3 days previously. Physical examination at admission found tachypnea, with 60% saturation (in room air), edema at the angle of the right mandible, diffuse reduction of vesicular murmur, and calves free from clubbing. Angiotomography of the chest and laboratory tests were compatible with septic emboli, and cervical computed tomography confirmed a diagnosis of septic thrombophlebitis of the internal jugular vein. She was managed with antibiotics and given treatment for her symptoms. Lemierre syndrome most often occurs in young men and there is embolization to the lungs in up to 97% of cases. Rarely, the etiology of this syndrome may be tooth extraction. Computed tomography is the imaging method most often used for diagnosis and treatment is basically antibiotic. Surgery is thus rarely necessary.A síndrome de Lemierre caracteriza-se pela tromboflebite séptica da veia jugular interna, após uma orofaringite, com embolização séptica para o pulmão ou outros órgãos. Neste relato de caso, apresentamos uma paciente feminina, 37 anos de idade, com história de edema e dor em hemiface direita há três dias, associada a fadiga e dispneia progressiva há um dia. História de extração dentária do elemento 48 há três dias. No exame físico admissional, apresentava-se taquipneica, saturando 60% (em ar ambiente), com edema em ângulo da mandíbula direita, redução difusa do murmúrio vesicular e panturrilhas sem empastamento. Angiotomografia de tórax e exames laboratoriais foram compatíveis com quadro de embolia séptica, e tomografia computadorizada da cervical corroborou o diagnóstico de tromboflebite séptica da veia jugular interna. Foi tratada com antibióticos e sintomáticos. A síndrome de Lemierre afeta mais homens jovens e tem embolização para o pulmão em até 97% dos casos. Extrações dentárias raramente podem ser a etiologia dessa síndrome. A tomografia computadorizada é o método de imagem mais utilizado no diagnóstico, e o tratamento é, essencialmente, com antibióticos; portanto, a abordagem cirúrgica é raramente necessária.Palavras-chave: síndrome de Lemierre; extração dentária; tromboflebite; embolia pulmonar. Lemierre syndrome: case report 338 338/340 J Vasc Bras. 2018, Out.-Dez.; 17(4):337-340

Lemierre Syndrome: Incidental Finding of Forgotten Fatal Disease as a Complication of Ludwig’s Angina

“…7 Our patient presented with worsening neck swelling for three weeks, shortness of breath, and fever, similar symptoms noted in previous studies. 3,8 Also, neck extension and rotation were painful and limited in our case. The patient developed Lemierre disease despite getting oral antibiotics in this case report.…”

“…The diagnosis of classical Lemierre syndrome is based mainly on a clinical one fulfilling three criteria: oropharyngeal infection, metastatic infection, and internal jugular vein thrombophlebitis or thrombosis. 1 , 3 , 4 , 8 In the current case, contrast-enhanced computed tomography (CT) of the neck and chest revealed multiple hypodense lesions with peripheral contrast enhancement in the bilateral perivertebral, submental, anterior cervical, and right supraclavicular regions (Abscesses), diffuse thickening and edema of the neck skin and subcutaneous area with emphysematous appearances (Necrotising fasciitis of the neck), multiple small-sized and peripherally located solid nodules in the upper lobes of the lungs (Septic emboli), and bilateral internal jugular vein filling defects indicative of high-grade partial occlusion due to septic thrombus formation.…”

Lemierre Syndrome: A Diagnosis behind the Veil

“…Regarding the duration of antibiotics, Riordan, 2007, referenced an estimate of 9 to 84 days with an average of 42 days [2]. We have analyzed 26 cases of LS from 2016 to 2021, and the average antibiotics duration was 5.3 weeks (Table 2) [4,17,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][42][43][44]. In clinical practice, due to the lack of an established guideline, the duration and selection of antibiotics highly varied based on clinical responses in patients.…”