Descending necrotizing mediastinitis secondary to pharyngitis - A case report

The patient was a 38-year-old female with descending necrotizing mediastinitis (DNM) originating from pharyngitis. The pus from infection by Bacteroides and aerobic streptococci had collected in the anterior and posterior mediastinum and bilateral thoracic cavity. Systemic antibiotic treatment with clindamycin and gentamycin was administered promptly after admission under a diagnosis of DNR I, without waiting for results of culture and sensitivity studies. Four puncture drainages were performed by echo-guide to treat bilateral empyema and left upper mediastinal pus collections. Additional surgical drainage via the transcervical approach was performed to drain right upper mediastinal pus. The patient was discharged on hospital day 50, and has since been in good health. Proper drainage at all pus collection sites by echoguide as well as prompt administration of antibiotics directed at both aerobic and anaerobic organisms are essential in the treatment of DNM.