Rapidly propagating descending necrotizing mediastinitis as a consequence of intravenous drug use.
Descending necrotizing mediastinitis (DNM) is a devastating complication of cervical or odontogenic infections that can spread downward to the mediastinum through anatomic spaces. We report the case of an intravenous drug user who presented with rapidly propagating acute pericarditis and DNM as the early presentations of pyomyositis of the sternocleidomastoid muscle and deep neck infection. The patient was successfully treated with antibiotics and surgical drainage. Clinicians should be aware that pathogens injected into the carotid sheath may spread to the mediastinum and/or pericardium and manifest as DNM and/or pericarditis prior to infectious signs and symptoms at the site of injection.
Lin
Yen-Yue
YY
Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
Hsu
Chin-Wang
CW
Chu
Shi-Jye
SJ
Chen
Shin-Chieh
SC
Tsai
Shih-Hung
SH
D000328:Adult; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D008482:Mediastinum / Q000473:pathology / Q000601:surgery; D009336:Necrosis; D010493:Pericarditis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D052880:Pyomyositis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000382:microbiology; D013616:Tachycardia, Sinus / Q000209:etiology / Q000503:physiopathology; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed