SORE THROAT GONE BAD: DESCENDING NECROTIZING MEDIASTINITIS

TOPIC: Chest Infections TYPE: Fellow Case Reports INTRODUCTION: Descending necrotizing mediastinitis (DNM) is a rare yet dangerous complication of oropharyngeal infections with mortality rates up to 50%. DNM was first described in 1983 and it clinically manifests as sequalae primary odontogenic or pharyngeal infectious focus supporting radiological features mediastinitis. Due its high rates, prompt imaging initiation antibiotics remains cornerstone management. CASE PRESENTATION: A 42 year old male came our emergency department complaints sore throat, fever, chills, odynophagia hoarseness for 2 days. He reported having throat few weeks which he did not seek treatment. septic on arrival WBC count 17.9 CT scan the neck showing extensive right peritonsillar abscess extending retropharynx uvula. The patient initially started Clindamycin subsequently switched Unasyn Azithromycin. Repeat day 4 showed improvement but continued spike fevers developed recurrent hemoptysis. Antibiotics were changed Vancomycin + Piperacilin/Tazobactam underwent laryngoscopy subsequent tonsillectomy parapharyngeal space exploration. improved repeat 12 paratracheal mediastinal abscesses, into posterior mediastinum behind esophagus concerning descending abscess. multidisciplinary team meeting conducted thoracic surgeon consensus continue perform periodic surgery if deteriorates. narrowed when tonsillar cultures S.Viridans sensitive Piperacilin/Tazobactam. completed 24 antibiotic regimen discharged home complete Augmentin therapy. On follow clinic later made recovery. DISCUSSION: can be fatal Our previously healthy who progressed through full spectrum pharyngitis; ranging from simple infection eventually DNM. incidence, there diagnostic therapeutic delay patient. However due multi disciplinary approach comprising hospitalist, critical care physician, radiologist, ENT cardiothoracic recovery without undergo surgical intervention. Awareness should addressed so that timely intervention performed. CONCLUSIONS: We recommend physicians keep differential routine management pharyngeal/odontogenic fails. REFERENCE #1: Sancho LM, Minamoto H, Fernandez A, et al. mediastinitis: retrospective experience. Eur J Cardiothorac Surg 1999; 16: 200–205 #2: Scaglione M, Pinto Romano S, Determining optimum CT; experience 32 cases. Emerg Radiol 2005; 11: 275–2 #3: Mihos P, Potaris K, Gakidis I, Management Oral Maxillofac 2004; 62: 966–972. DISCLOSURES: No relevant relationships by carol epstein, source=Web Response Steven Epstein, Huzaifah Salat,