title: Rapidly propagating descending necrotizing mediastinitis as a consequence of intravenous drug use.
abstract: 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.
authors: Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors: Yen-Yue
authors: YY
authors: Lin
authors: Chin-Wang
authors: CW
authors: Hsu
authors: Shi-Jye
authors: SJ
authors: Chu
authors: Shin-Chieh
authors: SC
authors: Chen
authors: Shih-Hung
authors: SH
authors: Tsai
mesh_terms: 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