顔面・頸部蜂巣炎を契機としたMRSAによるLemierre症候群例

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Lemierre's syndrome is thrombophlebitis of the internal jugular vein due to head and neck infections, mainly oropharyngeal, and causes metastatic abscess such as in the lung. We report herein on a case of Lemierre's syndrome following cervical cellulitis due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infection. A 47-year-old woman with no particular past medical history presented to our hospital with a complaint of right neck swelling. She had a high grade fever, cough, and slight difficulty in breathing. Her submandibular area was swollen and red. Laboratory data showed an increase in white blood cells, C-reactive protein, D dimer and FDP. Contrast-enhanced computed tomography revealed cellulitis of the right submandibular area, right internal jugular vein thrombosis, and multiple lung nodules, which indicated septic emboli. MRSA was detected in her blood culture. She was diagnosed as having Lemierre's syndrome, and intravenous linezolid and heparin were administered. Her thrombus and pulmonary lesions disappeared and she was discharged from hospital on the 41st hospital day. Lemierre's syndrome caused by MRSA is a very rare but treatable disorder. Not only should we consider Fusobacterium necrophorum, the most common organism of Lemierre's syndrome, as the cause, but also other organisms including MRSA, regardless of it being a community–acquired infection. Empiric anti-MRSA therapy should be performed especially when Lemierre's syndrome is suspected to be caused by dermal infection in the head and neck region.

顔面・頸部蜂巣炎を契機としたMRSAによるLemierre症候群例

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