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2019

ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

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LEMIERRE’S SYNDROME IN A TEENAGER PRESENTING AS PULMONARY SEPTIC EMBOLISM

Rui Domingues1, João Neves1,2, Flora Candeias1, Paula Kjollerstrom4, Ivan Bravio3, Maria João Brito1

1- Unidade de Infecciologia, Área da Mulher, Criança e Adolescente, Hospital de Dona Estefânia, Centro Hospitalar Lisboa Central EPE, Lisboa
2 - Unidade de Cuidados Intensivos, Área da Mulher, Criança e Adolescente, Hospital de Dona Estefânia, Centro Hospitalar Lisboa Central EPE, Lisboa
3 - Unidade de Cirurgia Torácica, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Lisboa
4 - Unidade de Hematologia, Área da Mulher, Criança e Adolescente, Hospital de Dona Estefânia, Centro Hospitalar Lisboa Central EPE, Lisboa

- 2016 European Society for Paediatric Infectious Diseases Conference, Brighton UK, 10-14 de Maio de 2016 (Poster)

Resumo:
Introduction Lemierre's syndrome is a rare disease characterized by septic thrombophlebitis of the internal jugular vein, after an acute pharyngeal infection, followed by metastatic infection to the lungs or central nervous system. This disease is easily missed and may be more common than generally appreciated.
Clinical case: A 17 year-old adolescent girl was diagnosed with acute viral pharyngitis a week before the admission. She had persistent fever in the last 7 days, and in the day of the hospitalization she presented cough, thoracic pain and dyspnea. She had cervical lymphadenopathies, a painful mass above the left clavicle and severe hypoxemia. The laboratory revealed leukocytosis (24.000/mcL), anemia (Hb 10.6mg/dL), thrombocytopenia (22.000/mcL) and elevated CRP (194.3mg/L). She was admitted in the intensive care unit and received non-invasive ventilation. A diagnosis of Lemierre’s syndrome was evoked and she was treated with ceftriaxone and clindamycin. A diagnosis of septic thrombophlebitis of the internal jugular vein was confirmed by Doppler and she was treated with low-molecular weight heparin on D5 because of progressive thrombosis and she improved dramatically. An angio-CT performed on D15 confirmed massive pulmonary thromboembolism and shown a lateral mediastinal mass, later confirmed to be a bronchogenic cyst. The infectious and auto-immune workup was inconclusive. All cultures were negative.
Conclusion: A high index of suspicion is required for the diagnosis of Lemierre’s syndrome. In young children it is usually a complication of a deep neck abscess but in adolescents and young adults it can complicate a milder disease and have a sudden presentation of short-breathness and hypoxemia. Accurate diagnosis and orientation is mandatory for the treatment of an otherwise potentially life-threatening disease.

Palavras Chave: Lemierre's syndrome, septic thrombophlebitis.