Descending necrotizing mediastinitis complicating hyperimmunoglobulin E syndrome

Abstract

Descending necrotizing mediastinitis (DNM) is a potentially lethal disease that originates from a deep neck infection (DNI); it is often associated with an immunocompromised state. Hyperimmunoglobulin E syndrome (HIES) is an extremely rare complex immune deficiency characterized by recurrent abscesses of staphylococcal etiology. A rare case of a 34‐year‐old woman wherein HIES putatively promoted the development of DNI into DNM is described. She presented with cervical purulent lymphadenitis and retropharyngeal abscess. Despite immediate cervical drainage and use of broad‐spectrum antibiotics, she developed DNI and subsequently DNM. Mediastinal drainage with thoracotomy and subsequent deep neck drainage were performed. Bacterial culture of the abscess isolated methicillin‐resistant Staphylococcus aureus (MRSA). Although a postoperative recurrent deep neck abscess required a second surgery, we succeeded in conservative remission of recurrent mediastinal abscess with long‐term use of anti‐MRSA drugs. Sufficient drainage under thoracotomy and robust administration of postoperative antibiotics resulted in successful management of HIES‐associated DNM.

Necrotizing Mediastinitis Following Rabbit Bone Ingestion: A Case Report

“…Descending necrotizing mediastinitis (DNM) is characterized by complications resulting from odontogenic or oropharyngeal infections that spread to the cervical facial space. Finally, DNM descends to the mediastinum (8). Since the infection has a potential to spread, the early diagnosis of DNM is imperative (9).…”

“…The symptoms vary greatly but usually include chest pain, dyspnea, pleural and pericardial effusion, sore throat, sputum, coughing, chest tenderness, fever, and submandibular and neck edema (6). The standard treatment for deep neck and chest infections like mediastinitis is to manage the airway with intubation (2), cricothyroidotomy, and tracheostomy and to then drain infected abscesses from the neck (7), mediastinal space, and fascia (8). The purpose of this report is to describe a case of necrotizing mediastinitis caused by a foreign body.…”