Thoracic necrotizing fasciitis due to snake ointment that progressed to a mediastinitis

Abstract

We report the case of a 42-year old diabetic male presenting with erythema of the neck and anterior right thoracic region secondary to the application of an ointment derived from rattlesnakes, progressing to a full-blown necrotizing fasciitis in a short period of time, with associated mediastinitis, thrombocytopaenia and sepsis. The patient died despite aggressive multidisciplinary medical and surgical treatment. We present this case due to the unusual aetiology and fulminating course.

Descending necrotizing mediastinitis below the tracheal carina

“…Historically, the main sources of DNM have been described as odontogenic, peritonsillar or other retropharyngeal infections, but various etiologies have been described by our group and others. [4][5][6][7] Surgical treatment includes transcervical, transthoracic, or mixed approaches. 8,9 Recently, video-assisted thoracoscopic surgery has gained acceptance among thoracic surgeons.…”

Descending necrotizing mediastinitis and sternoclavicular joint osteomyelitis

“…The most frequent etiology of nonsurgical mediastinitis is odontogenic abscesses, followed by deep cervical involvement and descent into the mediastinum; other rare etiologies have been reported. 1,2 Sternoclavicular joint osteomyelitis culminating in full-blown mediastinitis has been reported only once as the etiology of this dreadful disease. 3 We describe a case of this association and underscore its favorable course during a lengthy hospital stay.…”