Objective To emphasize the importance of the early diagnosis and treatment of Lemierre syndrome caused by Arcanobacterium haemolyticum.Method A case of Lemierre syndrome caused by Arcanobacterium haemolyticum and three similar reported cases were reviewed.Results A man complained of fever with a sore throat,and examination found an enlarged left tonsil with prominent exudate,normal blood routine test and chest radiograph.Although the patient received the treatment of penicillin G and azithromycin,his condition worsened.Blood test showed white blood cell count 13.59 × 109/L (neutrophils 0.933),platelet count 7.4 × 109/L,TBil 54.3 mmol/L,DBil 28.3 mmol/L,AST 127 IU/L,ALT 82 IU/L,serum albumin 19.3 g/L with the development of the conditions.Blood cultures grew Arcanobacterium haemolyticum and the piperacillin-tazobactam was administered until fever was controlled.In addition,anticoagulation was administered when the thrombus was confirmed in the left internal jugular vein.Two follow-up clinic visits over the following 4 months were unremarkable.Besides three similar cases reported,four patients were male,and the ages ranged from 19 to 54 years.The chief complaints were sore throat and fever (4/4),with neck pain (4/4).Physical examinations found pharyngitis (2/4),exudate or abscess in the tonsillar crypt (2/4),maculopapular rashes (2/4).Laboratory results showed leukocytosis and thrombocytopaenia (4/4),acute cholestatic liver dysfunction (3/4),acute renal failure (2/4),acute respiratory failure (1/4).The first chest radiographs were normal at the onset,but chest radiography features included peripheral nodules and cavitation (3/4),focal or wedge-shaped lesions (1/4),pleural effusion (1/4) with the development of the conditions.Blood culture proved that there was only growth of Arcanobacterium haemolyticum (2/4),both Fusobacterium necrophorum and Arcanobacterium haemolyticum were found (2/4).Amoxicillin/clavulanic acid or piperacillin/tazobactam was administered (4/4).Neck CT proved internal jugular vein thrombosis (3/4) and anticoagulation was administered (3/4).All patients recovered and no one died.Conclusions The characters of Lemierre syndrome include primary oropharynx infection,septicaemia,septic or embolic phlebitis of jugular vein,and metastatic abscess.Early recognition and aggressive intravenous broad-spectrum antibiotics are critical to reduce mortality.%目的 提高对溶血隐秘杆菌致Lemierre综合征的认识及诊治水平.方法 分析1例溶血隐秘杆菌致Lemierre综合征的临床特点,并进行文献复习.结果 患者男,无诱因发热伴咽痛,体检发现左侧扁桃体充血、肿大,血常规正常,X线胸部正位片未见异常.初步诊断:急性扁桃体炎(左侧).予青霉素+阿奇霉素治疗后,症状加重,查白细胞计数13.59×109/L,中性粒细胞比例0.933,血小板计数7.4×109/L;TBil 54.3 mmol/L,DBil 28.3 mmol/L,AST 127 IU/L,ALT 82 IU/L,血清白蛋白19.3 g/L.血培养结果为溶血隐秘杆菌,改静脉滴注哌拉西林-他唑巴坦治疗后体温恢复正常.随后患者出现左侧颈内静脉血栓形成,予抗凝治疗.出院后2个月和4个月时随访患者,未见异常.检索文献3例,结合本例共4例,4例患者均为男性,年龄19 ～54岁,均以咽痛和发热为首发和主要症状,均伴有颈部疼痛；咽炎2例,扁桃体周围渗出或脓肿各1例,皮疹2例；血白细胞计数均升高,血小板计数均下降,肝功能损伤3例,急性肾衰竭2例,急性呼吸衰竭1例；首查X线胸片均正常,病情进展后胸部X线或CT提示双肺周边多发结节高密度影伴空洞形成3例,局灶或楔形浸润影1例,胸腔积液1例；血培养结果提示单一溶血隐秘杆菌2例,溶血隐秘杆菌和坏死梭形杆菌复合感染2例；4例患者均应用青霉素+酶抑制剂治疗有效；有血栓者予抗凝治疗；无死亡病例.结论 Lemierre综合征临床特点有原发口咽部感染、脓毒血症、感染性或栓塞性颈静脉炎及至少一处远处化脓灶,早期诊断、及时治疗可降低溶血隐秘杆菌致Lemierre综合征病死率.
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