Successful perioperative management of a case of infective endocarditis secondary to a Lemierre's syndrome variant with severe neurological manifestations

Morishige Shoji; Oe Masahiro; Goto Takeyuki; Ishimaru Toshiyuki

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Successful perioperative management of a case of infective endocarditis secondary to a Lemierre's syndrome variant with severe neurological manifestations

机译：成功的围手术期治疗一种患有严重神经表现的Lemierre综合征变异的感染性心内膜炎的情况

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Lemierre's syndrome (LS) is characterized by septic thrombophlebitis of the internal jugular vein with septicemia and metastatic infection following an oropharyngeal infection. LS is rare but can cause infective endocarditis (IE), complicating IE management. We report a case of IE secondary to thrombophlebitis in the left vertebral vein following pharyngitis (LS variant) with distinctively severe manifestations, including metastatic infection and severe neurological impairment with multiple cerebral infarctions. A pedunculated abscess was noted on the left ventricular free wall. Despite the patient's highly impaired consciousness level (i.e., comatose state), we performed early surgery to remove the abscess after excluding LS-related brain complications. Preoperative antibiotics included clindamycin to cover LS-related anaerobic bacteria, and thrombophlebitis required postoperative anticoagulation. By managing LS as well as IE, the infection was controlled, and the neurological status normalized. This report provides insights into the perioperative management of IE secondary to LS.

机译：Lemierre综合征（LS）以颈内静脉败血性血栓性静脉炎为特征，并伴有口咽部感染后的败血症和转移性感染。LS很少见，但可引起感染性心内膜炎（IE），使IE治疗复杂化。我们报告了一例继发于咽炎（LS变异）后左椎静脉血栓性静脉炎的IE病例，其明显的严重表现包括转移性感染和多发性脑梗死的严重神经损伤。左心室游离壁可见有蒂脓肿。尽管患者的意识水平严重受损（即昏迷状态），但在排除LS相关的脑部并发症后，我们进行了早期手术以清除脓肿。术前抗生素包括克林霉素以覆盖LS相关厌氧菌，血栓性静脉炎需要术后抗凝。通过管理LS和IE，感染得到了控制，神经状态正常化。本报告对LS继发IE的围手术期处理提供了见解。

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《Journal of cardiac surgery.》 |2021年第9期|共4页
作者
Morishige Shoji; Oe Masahiro; Goto Takeyuki; Ishimaru Toshiyuki;
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作者单位

Fukuoka Red Cross Hosp Dept Cardiovasc Surg Fukuoka Japan;

Fukuoka Red Cross Hosp Dept Cardiovasc Surg Fukuoka Japan;

Fukuoka Red Cross Hosp Dept Infect Dis Med Fukuoka Japan;

Fukuoka Red Cross Hosp Dept Infect Dis Med Fukuoka Japan;

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正文语种 eng
中图分类心脏血管和淋巴系外科学;
关键词
infective endocarditis; Lemierre's syndrome; thrombophlebitis;

机译：感染性心内膜炎;Lemierre的综合症;血栓性炎;

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Successful perioperative management of a case of infective endocarditis secondary to a Lemierre's syndrome variant with severe neurological manifestations

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