内頸動脈海綿静脈洞瘻のプラチナコイル塞栓術後に脳膿瘍を合併したLemierre症候群の1例(Lemierre syndrome with brain abscess following platinum coil embolization for internal carotid artery cavernous sinus fistula: A case report)

• Published in: Nihon Kyūkyū Igakkai zasshi 2024-02, Vol.35 (2), p.45-51
• Main Authors: 裕介, 清水, 勇希, 持田, 良平, 西沢, 賢彦, 海田, 芳裕, 山口
• Format: Article
• Language: English
• Subjects: Fusobacterium species; Fusobacterium属; internal jugular vein thrombophlebitis; liver abscesses; 内頸静脈血栓性静脈炎; 肝膿瘍
• ISSN: 1883-3772; 1883-3772
• DOI: 10.1002/jja2.12862

要旨 Lemierre症候群は口腔咽頭領域の感染症を契機として内頸静脈の血栓性静脈炎と遠隔臓器感染を起こす，抗菌薬の発展とともに激減した症候群である。今回我々は，内頸動脈海綿静脈洞瘻のコイル塞栓術後に歯周病が波及し脳膿瘍と肝膿瘍を合併したLemierre症候群の１例を経験した。症例は60歳代の男性。外傷性内頸動脈海綿静脈洞瘻に対する経動静脈プラチナコイル塞栓術の１か月後に発熱と意識障害を主訴に救急搬送された。CTにて脳膿瘍と肝膿瘍を認めたため，それぞれ穿頭ドレナージと経皮経肝ドレナージを施行した。血液培養検査からFusobacterium naviformeが検出され，歯周炎と内頸静脈内の血栓も確認できたことからLemierre症候群と診断した。脳膿瘍は一度縮小傾向であったが再度増大し膿瘍が脳室穿破したため内視鏡的膿瘍除去術を施行し，その後は抗菌薬加療で膿瘍再増大を認めず，入院79日目にリハビリ転院となった。Lemierre症候群による脳膿瘍形成は稀であるが，頭蓋内病変に対するプラチナコイル塞栓後の脳膿瘍形成も同様に稀である。コイル術後の膿瘍形成の場合には，Lemierre症候群の可能性も考慮し早期に感染巣の全身検索を行うことが肝要である。 ABSTRACT Incidence of Lemierre syndrome, where an infection in the oropharyngeal region leads to internal jugular vein thrombophlebitis and distant organ infections, has significantly decreased with the advancement of antibiotics. We encountered a case of Lemierre syndrome in which brain and liver abscesses developed after coil embolization for an internal carotid artery cavernous sinus fistula with periodontal disease. A male in his 60’s was brought to the emergency department with complaints of fever and altered consciousness one month after undergoing coil embolization for a traumatic internal carotid artery cavernous sinus fistula. Computed tomography scans revealed brain and liver abscesses, and drainage procedures were performed. Blood cultures showed Fusobacterium naviforme. Periodontal inflammation and thrombosis in the internal jugular vein were also observed. The brain abscess initially decreased, but later enlarged and perforated the brain ventricle, requiring endoscopic removal. Subsequent treatment with antibiotics led to improvement and the patient was transferred to another facility on the 79th day of hospitalization. Brain abscess formation due to Lemierre syndrome and after platinum coil embolization for intracranial lesions is rare. In a case such as this, early consideration of the possibility of Lemierre syndrome and comprehensive systemic investigation for infectious sources are crucial.