Abstract
Descending necrotizing mediastinitis is a severe infection of the mediastinum. This syndrome manifests as fever and chest pain following cough and sputum production. A 49-year-old woman presented with fever and a 14-day history of pneumonia. CT showed mediastinal abscesses with a giant calcified mediastinal lymph node (21 × 18 mm) and pneumonia. Bronchoscopy by EBUS-TBNA under general anesthesia was performed. The pathogen found in the puncture culture was Streptococcus constellatus, and antibiotics (mezlocillin/sulbactam 3.375 IVGTT q8h) was administered. A proximal right main bronchial neoplasm, suspected lung cancer, was found and conformed to inflammatory granuloma. A total of 22 months post-discharge the patient was clinically stable. We also conducted a review of the literature for all Streptococcus constellatus descending necrotizing mediastinitis infections between 2011 and 2017.
Highlights
Descending necrotizing mediastinitis (DNM) is an uncommon disease when the widespread antibiotics are used today, but accompanied by life threatening complication of infection in the oropharyngeal region that descends to the mediastinum through the connecting deep and superficial cervical fascial planes
DNM is even more rarely caused by Streptococcus constellatus, a microorganism usually found in the normal flora of the human body [4]
Following an inhalation of Streptococcus constellatus originated from the upper airways could develop descending necrotizing mediastinitis
Summary
Descending necrotizing mediastinitis (DNM) is an uncommon disease when the widespread antibiotics are used today, but accompanied by life threatening complication of infection in the oropharyngeal region that descends to the mediastinum through the connecting deep and superficial cervical fascial planes. The mortality rate of DNM is about 41%. It is approximately triples the risk of septic shock [1,2,3]. Case report A 49-year-old female with a history of dental caries seeked medical advice to the outpatient Respiratory clinic with progressive fever. Her temperature fluctuated from 37.6 to 38.9 °C, following chest pain and productive. It was conformed to inflammatory granuloma (Fig. 2c, d) This benign lesion was treated with bronchoscopic biopsy forceps and never cured with an ablative endoscopic procedure.
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