Descending necrotizing mediastinitis with Lemierre’s syndrome

• Published in: General thoracic and cardiovascular surgery Vol. 65; no. 11; pp. 661 - 663
• Main Authors: Kaiho, Taisuke, Nakajima, Takahiro, Yonekura, Shuji, Hamasaki, Sawako, Iwata, Takekazu, Yoshino, Ichiro
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.11.2017; Springer Nature B.V
• Subjects: Abscesses; Anti-Bacterial Agents - therapeutic use; Antibiotics; Anticoagulants; Cardiac Surgery; Cardiology; Case Report; Conflicts of interest; Drainage - methods; Female; Humans; Infections; Lemierre Syndrome - complications; Lemierre Syndrome - diagnosis; Mediastinitis - diagnosis; Mediastinitis - microbiology; Mediastinitis - therapy; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neck; Necrosis; Ostomy; Patients; Pleural effusion; Pulmonary embolisms; Sinuses; Streptococcal Infections - diagnosis; Streptococcal Infections - microbiology; Streptococcal Infections - therapy; Streptococcus constellatus - isolation & purification; Surgical Oncology; Thoracic Surgery; Thrombosis; Tomography, X-Ray Computed; Veins & arteries; Descending necrotizing mediastinitis; Septic pulmonary embolization; Lemierre’s syndrome
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-016-0742-0

Descending necrotizing mediastinitis is a severe infection of the mediastinum. Lemierre’s syndrome manifests as thrombophlebitis in the cervical veins, which is caused by a neck infection. A 50-year-old woman had a fever with a 13-day history of neck pain. CT showed a deep neck abscess with vertebral vein thrombosis and mediastinal abscesses. Multiple small pulmonary nodules were found, suggesting septic pulmonary embolism. Emergency surgery for bilateral cervical and mediastinal drainage was performed, and antibiotics and anticoagulation agent was administered. Edoxaban was required to clear vein thrombosis and pulmonary embolization.