Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/S1677-54492010005000001
Jornal Vascular Brasileiro
Case Report

Síndrome de Lemierre: relato de caso

Lemierre syndrome: case report

Gustavo Ioshio Handa; Giorgio Sfredo Bertuzzo; Karin S. Muller; Ana Cláudia Dambinski; Vinicius Zendrini Buzingnani; Lucas Marques Mantovani; Andressa Hubar Patriani; Denise Krauss

http://dx.doi.org/10.1590/S1677-54492010005000001 J Vasc Bras, vol.9, n1, p.82-85, 2010
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Resumo

A síndrome de Lemierre é uma doença rara, mais comum em jovens, causada frequentemente pelo Fusobacterium necrophorum. Inicia-se com faringite e propaga-se até a veia jugular interna, promovendo uma fonte de bacteremia contínua e êmbolos sépticos pulmonares. Manifestações clínicas incluem febre, alterações respiratórias e massa cervical. O diagnóstico é realizado por tomografia computadorizada e duplex scan, além de hemocultura ou cultura direta. O tratamento é realizado com antibióticos beta-lactâmicos resistentes a beta-lactamases, sendo a cirurgia raramente necessária. Paciente do sexo feminino, 34 anos, com quadro de orofaringite, evoluiu em 48 horas com queda do estado geral, febre, aumento de volume e dor em região cervical esquerda. Radiografia e tomografia de tórax evidenciaram múltiplas lesões pulmonares. A tomografia cervical e o duplex scan confirmaram a trombose da veia jugular interna, compatível com tromboflebite supurativa aguda, a síndrome de Lemierre. Após antibioticoterapia, o paciente apresentou melhora do quadro clínico. O duplex scan de controle evidenciou recanalização venosa.

Palavras-chave

Trombose venosa, veias jugulares, infecções por Fusobacterium

Abstract

Lemierre syndrome is a rare disease. It often affects young adults and is most frequently caused by Fusobacterium necrophorum. The initial event is pharyngitis, which extends to the internal jugular vein, serving as source of continuous bacteremia and septic pulmonary emboli. Clinical manifestations include fever, respiratory distress, and swollen cervical lymph nodes. Diagnosis is established based on blood culture or direct blood culture and confirmed by computed tomography and/or duplex scan. Treatment consists of administration of beta-lactamase resistant beta-lactam antibiotics. Surgical exploration is rarely required. A 34-year-old woman with acute oropharyngeal infection presented 48 hours later with prostration, fever, and swollen and painful cervical lymph nodes on the left side of the neck. Chest radiography and tomography demonstrated multiple lung lesions. Computed tomography and duplex scan demonstrated thrombosis of the internal jugular vein, compatible with acute suppurative thrombophlebitis, also known as Lemierre syndrome. The patient received antibiotics and had clinical recovery. A control duplex scan demonstrated partial recanalization of the internal jugular vein.

Keywords

Venous thrombosis, jugular veins, fusobacterium infections

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