抗菌薬と抗凝固薬で治療し，画像を中心にその経過を観察することができたLemierre症候群の1例

The Imaging Course of a Case with Lemierre's Syndrome who was Treated by Antibiotic and Anticoagulant Therapy

要旨　患者は37歳，男性．発熱，頸部腫脹を主訴に受診，急性扁桃腺炎の診断で，抗菌薬(CDTRI-PI)を処方された．内服後より，扁桃炎は軽快したが，2週間後から再度発熱，頸部腫脹を認め，当院耳鼻咽喉科を受診した．CT写真で両肺野に多発する結節影ならびに30mm大の頸部腫瘤を認めたため，当科紹介となった．頸部エコーで，腕頭静脈から右頸静脈に血栓を認めた．急性扁桃炎を契機に内頸静脈の血栓性静脈炎を合併し，続発する肺の多発結節影(septic emboli)を認めたことからLemierre症候群と診断した．抗菌薬(SBT/ABPC)の経静脈投与を行い，血栓に対しては抗凝固療法を開始した．抗菌薬は計8週間投与した．血栓は消失したが，静脈の狭小化を認めたため，抗凝固療法は継続している．最近の報告は少なくなっているが，致死的な合併症を来すことも知られ，忘れてはならない疾患の一つと考えられる．

　A 37-year-old man presented with high fever and neck swelling. He was finally diagnosed as having Lemierre's syndrome. First, he was managed as acute tonsillitis, and antibiotics(CDTRI-PI)had been prescribed by a previous physician. Although the tonsillitis recovered under antibiotic treatment, two weeks later, the symptoms, such as high fever and neck swelling, appeared again. At that point, multiple nodular shadows were detected in the patient's bilateral lungs, and a 30mm cervical abscess was found by CT scan. Thrombus of the brachiocephalic vein reaching to the right carotid vein was detected by cervical ultrasonography. We diagnosed Lemierre's syndrome, a condition involving septic thrombophlebitis of the internal jugular vein which had led to multiple lung abscesses. Intravenous antibiotic(SBT/ABPC)and anticoagulation therapy were administered for 8 weeks, and the patient has recovered. Anticoagulant therapy has been continued because of residue of the narrowed carotid vein, after the thrombus had disappeared.

　This case report discusses the importance of prompt diagnosis and treatment in Lumierre's syndrome which sometimes proves to be a fatal condition.