Infectious Thrombophlebitis of the Left Internal Jugular Vein Following Left Peritonsillitis

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  • 左扁桃周囲炎から左内頸静脈の化膿性血栓性静脈炎をきたした1例
  • ヒダリ ヘントウ シュウイエン カラ ヒダリ ナイ ケイ ジョウミャク ノ カノウセイ ケッセンセイ ジョウミャクエン オ キタシタ 1レイ

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Abstract

<p>Infectious thrombophlebitis is a disease in which septic inflammation occurs in the venous wall, resulting in intravenous thrombus formation; it is often complicated by pulmonary emboli and metastatic abscesses that occur in association with bacteremia. Here, we report a case in which the spread of infection from left peritonsillitis was considered to result in infectious thrombophlebitis of the left internal jugular vein. The patient was a 51-year-old man who had received antibiotics (piperacillin and levofloxacin) from a local otolaryngologist for the treatment of acute tonsillitis 8 days prior to an examination at our department. After the initial visit, the patient took no further action and did not return for a second examination. On day 8 after the initial examination, the patient returned for a second examination because of an exacerbation of a pharyngeal pain, high fever, and advanced left neck swelling. That same day, the patient was referred to our department for an examination because of a suspected left deep neck abscess. Contrast-enhanced computed tomography revealed thrombophlebitis in the left internal jugular vein and its branches. We performed an emergency tracheostomy and neck incision for drainage. We then administered antibiotics and performed anticoagulant therapy. The infection subsequently subsided, and the left internal jugular vein thrombus disappeared. However, recanalization of the vein has not been observed. Lemierre’s syndrome is a form of infectious thrombophlebitis in which an upper respiratory infection leads to internal jugular vein thrombophlebitis and systemic septic emboli. Although rare, the incidence of Lemierre’s syndrome has increased in recent years, and the course is often fatal. The present case was atypical in that lesions were observed in the neck only. Nevertheless, despite the rarity of Lemierre’s syndrome, it must be considered when diagnosing patients with symptoms such as those described above.</p>

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