Descending necrotizing mediastinitis secondary to retropharyngeal abscess in a child

Nonsurgical management of mediastinal abscess and Lemierre syndrome in an infant

“…The infection was caused by sensitive Staphylococcus aureus. A more recent case report described a 6-year old Japanese boy who sustained trauma to the neck and developed descending necrotizing mediastinitis caused by Streptococcus pyogenes [6]. The patient also did not require surgical drainage of the mediastinal abscess.…”

“…Recent case reports have suggested that descending necrotizing mediastinitis may not require surgical drainage when clinical and radiologie response is evident [5][6][7].Sztajnbok et al initially reported a 19month old female with a retropharyngeal abscess that extended into the mediastinum and did not require surgical drainage of the mediastinitis but responded to intravenous antibiotics alone [7]. The infection was caused by sensitive Staphylococcus aureus.…”

“…Four cases have been described where mediastinal drainage was not necessary and the mediastinal infection resolved with antibiotic therapy alone [4][5][6][7]. Of the four cases, one patient grew Streptococcus pyogenes, another grew methicillin-susceptible Staphylococcus aureus and a third case did not grow any organism.…”

“…Persistent leukocytosis and fever seem to be a significant feature [5][6][7], There is now an emerging body of literature that suggest pédiatrie mediastinitis due to retropharyngeal abscesses may be successfully managed without mediastinal drainage. This is in sharp contrast to the adult experience where mediastinal drainage is the norm.…”

“…Recent reports suggest that descending necrotizing mediastinitis is increasingly seen in children and that methicillin-resistant Staphylococcus aureus (MRSA) is emerging as an important pathogen in this disease [4,5]. In contrast to adults, the disease in children is not as lethal and non-surgical management of the mediastinal abscess is a possible option [5][6][7]. We report a case oían 8-month male with descending necrotizing mediastinitis who also had a Lemierre syndrome (LS) secondary to a retropharyngeal abscess that was treated with intravenous antibiotics and did not require drainage of the mediastinal abscess.…”