Severe mediastinitis over a month after endobronchial ultrasound‐guided transbronchial needle aspiration

Abstract

Although endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) has been reported to be a minimally invasive and relatively safe procedure, mediastinitis is a serious complication related to the procedure. The median time of mediastinitis onset is approximately 12 days after EBUS‐TBNA. Here we report two rare cases with mediastinitis onset 40 and 53 days after EBUS‐TBNA. Surgical drainage was performed since systemic treatment with antibiotics was insufficient in both cases. Eikenella corrodens , which is a slow‐growing microorganism, was identified as the causative pathogen in one case. To our knowledge, this is the first report of mediastinitis occurring over a month after EBUS‐TBNA. Clinicians should consider the diagnosis of mediastinitis even if symptoms appear over a month after EBUS‐TBNA.

Delayed onset of mediastinitis with tracheomediastinal fistula following endobronchial ultrasound‐guided transbronchial needle aspiration; A case report

“…In studies of endoscopic fine needle aspiration, cystic or necrotic lesions were associated with postoperative infectious complications 15 . However, as in our case, mediastinitis occurred in some cases, even when the lesions were noncystic and non‐necrotic 11 . The number of samples obtained by EBUS TBNA for each LN and unskilled operator can also be possible risk factors for mediastinitis 3 .…”

“…Among these complications, infectious complications can be serious and require surgical treatment 3,7–9 . They are associated with a longer duration of hospitalization and delayed initiation of subsequent anticancer treatment after diagnosis 10,11 . Infectious complications after EBUS TBNA are rare; a systematic review and a national survey previously reported the rate of infectious complications was 0.02%–0.19% 4,12,13 …”

“…Despite variability in the timing of mediastinitis onset after EBUS‐TBNA, most cases of mediastinitis occurred within three weeks after EBUS‐TBNA 3,7–9 and the median time of mediastinitis onset in 13 cases was 12.5 days 11 . One study reported delayed onset in two cases, in whom mediastinitis occurred in patients 40 and 53 days after EBUS‐TBNA 11 .…”

“…Thus, prophylactic antibiotics might be considered for EBUS‐TBNA of cystic or necrotic lesions. Prophylactic antibiotics that are effective against pathogens found in the oral cavity should be administered since these pathogens have been frequently identified as the cause of mediastinitis after EBUS‐TBNA 11 . In addition, oral care should be performed before the procedure in order to decrease the risk of infection due to oral cavity pathogens.…”

Pneumonia, pleurisy, mediastinitis, and mediastinal cyst infection secondary to endobronchial ultrasound-guided transbronchial needle aspiration

“…[ 11 ] The use of EBUS-TBNA has related complications such as secondary infection and hemorrhage, especially for cystic lesions, which seems to have a greater potential to develop cystic infection, lung abscess, pleural infection or mediastinal infection than solid lesions of the mediastinum. [ 4 , 6 , 9 , 13 , 16 , 25 ] The reported infectious pathogens include Streptococcus, [ 5 – 6 , 16 – 17 , 24 – 25 , 30 – 31 ] Coryneform bacteria and Prevotella melaninogenica, [ 5 ] Staphylococcus, [ 4 , 24 ] Mycobacterium tuberculosis, [ 21 ] Haemophilus Influenza, [ 32 ] Eikenella corrodens, [ 24 , 33 ] Klebsiella pneumonia, Actinomyces odontolyticus, Gemella morbillorum, Prevotella buccae, Actinomyces, [ 30 ] among which the most of the reported bacteria are oral flora. During the procedure of EBUS-BNA, the bronchoscope and needle may be contaminated when passing through the oropharynx, thus carrying bacteria of the oral flora into the cyst.…”