DOI: 10.36347/sjmcr.2018.v06i01.015

Pages: 49-51

An 84-year-old woman became unconscious and febrile after complaining of general pain. Her past history included gastrectomy for gastric cancer, hypertension, cerebral infarction and femur fracture; however, she was able to live independently. On arrival, her Glasgow Coma Scale score was 11. A physical examination revealed the following findings: blood pressure, 130/66 mmHg; a heart rate, 86 beats per minute; respiratory rate, 30 breaths per minute; SpO2, 90 % under room air; and body temperature, 38.0°C. Her left neck and anterior chest showed redness and swelling. Computed tomography to detect the focus of sepsis revealed retropharyngeal, deep neck and periaortic fluid collection, suggesting descending mediastinitis (DM). During investigations to identify the cause of the patient’s unconscious state, her blood pressure and respiratory function deteriorated; thus, tracheal intubation was performed. She was moved to the intensive care unit and drainage of the retropharyngeal abscess was performed. She was treated with multiple drugs and the presence of refractory shock. She also received tracheostomy, including the opening of the superior mediastinal space. After these treatments, her respiration and circulation became stable. Streptococcus pyogenes was detected in the blood and abscess cultures. Finally, her tracheostomy spontaneously closed and she became able to feed herself. In the early stage of DM, a less invasive surgical approach in addition to multidisciplinary treatments may be effective for obtaining survival.