石灰沈着性頸長筋腱炎，咽後膿瘍との鑑別が困難で，Lemierre症候群をきたした椎前部膿瘍例

抄録

This is a report of a case of prevertebral abscess with Lemierre’s syndrome, which was difficult to differentiate from a retropharyngeal abscess and calcific tendinitis of the longus colli muscle.

A 49-year-old woman consulted her previous doctor with a one-month history of post-cervical pain. Brain MRI revealed no abnormalities and the patient was prescribed an analgesic. However, the symptoms worsened and the patient visited our emergency outpatient clinic. Based on the findings of CT and MRI, she was admitted to our department with a diagnosis of prevertebral abscess.

She was started on treatment with ceftriaxone and clindamycin, based on robust evidence of an inflammatory response in the blood tests, but her symptoms only continued to worsen. Later, she developed internal jugular vein thrombosis and bacteremia, which led to the diagnosis of Lemierre’s syndrome. A blood culture grew Streptococcus constellatus subsp. pharyngis and Parvimonas micra. Despite administration of tazobactam/piperacillin, the symptoms persisted, and the antibiotic was switched to meropenem. Thereafter, the symptoms gradually improved and resolved. A retrospective review of the case revealed that the Lemierre’s syndrome resulted from the prevertebral abscess rather than retropharyngeal abscess. The fact that interdisciplinary management involving the fields of otorhinolaryngology and orthopedics is required for the treatment of prevertebral abscess, retropharyngeal abscess, calcific tendinitis of the longus colli muscle, and infectious spondylitis, and that each disease involves areas in anatomically close proximity make it difficult to differentiate one from the other, and diagnosis and treatment are often delayed. In particular, all of these diseases, except calcific tendinitis of the longus colli muscle, require early diagnosis and early treatment since they could follow a serious course if treatment is delayed. In addition, Lemierre’s syndrome is usually caused by inflammation spreading from the pharynx; this was a rare case in which prevertebral abscess was the focus of infection.