title: Descending necrotizing mediastinitis associated with Lactobacillus plantarum.
abstract: BACKGROUND
  Descending necrotizing mediastinitis (DNM), a severe infection with a high fatality rate, develops in mediastinal spaces due mainly to deep cervical abscesses. The majority of causative microbes of DNM are Streptococci and oral anaerobes. DNM associated with Lactobacillus-infection is rather rare.
  
  
  METHODS
  A 69-year-old male with an unremarkable past medical history was referred to our hospital for surgical resection of advanced laryngeal cancer. Full examination revealed a neck abscess and DNM with a background of untreated diabetes mellitus. Initially, he was treated with meropenem. However, Lactobacillus plantarum was isolated from surgical drainage of a mediastinal abscess. Despite using antibiotics capable of eradicating all isolates with susceptibilities not differing significantly from those of the neck and mediastinal abscesses, we attributed DNM to the L. plantarum detected only in the mediastinal abscess. After DNM treatment, he underwent total pharyngolaryngectomy with bilateral neck dissection followed by reconstruction using free jejunum. He was discharged fully recovered.
  
  
  CONCLUSIONS
  We concluded that L. plantarum as the sole cause of the mediastinal abscess in the present case cannot be ruled out. As the number of immunocompromised patients increases, we should be cautious regarding this "familiar" microbe.
authors.affiliation: Department of Infection Control and Prevention, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. takahitonei@gmail.com.
authors.forename: Takahito
authors.initials: T
authors.lastname: Nei
authors.forename: Shunta
authors.initials: S
authors.lastname: Inai
authors.forename: Iwao
authors.initials: I
authors.lastname: Mikami
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
authors.forename: Junichi
authors.initials: J
authors.lastname: Okamoto
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yokoshima
authors.forename: Munenaga
authors.initials: M
authors.lastname: Nakamizo
authors.forename: Shuji
authors.initials: S
authors.lastname: Haraguchi
authors.forename: Kazunari
authors.initials: K
authors.lastname: Sonobe
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Saito
mesh_terms: D000038:Abscess / Q000188:drug therapy / Q000382:microbiology; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006801:Humans; D048191:Lactiplantibacillus plantarum / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D008297:Male; D008480:Mediastinitis / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents