背景:下降性坏死性纵隔炎(DNM)是一种罕见但严重的纵隔感染。如果没有及时诊断和治疗,后果可能非常严重。这里,我们分享了1例成功诊断和治疗的DNM病例,该病例由口腔至颈部和纵隔由星座链球菌(Sconstellatus)引起.Sconstellatus是一种临床上不常见的革兰氏阳性球菌,以其形成脓肿的能力而闻名。及时的手术引流和正确使用抗生素是成功治疗的关键。
方法:一名53岁男性因右颊疼痛肿胀入院,持续口腔脓液和中度发烧持续1周,随后是纵隔脓肿的快速发展。
方法:他被诊断为S星座引起的DNM。
方法:在入院的晚上,紧急气管切开术和胸腔镜右纵隔探查引流,嘴巴的地板,行咽旁脓肿和颈部脓肿。立即施用抗生素。
结果:术后28天,脓肿被吸收了,双侧肺渗出物减少,患者体温降低,天冬氨酸转氨酶,丙氨酸转氨酶,胆红素和血小板恢复正常。患者在完成抗生素治疗4周后出院。出院后3个月随访发现脓肿无复发。
结论:早期手术引流和抗生素治疗对于由小行星链球菌引起的纵隔脓肿和感染性休克很重要。
BACKGROUND: Descending necrotizing mediastinitis (DNM) is a rare but severe mediastinal infection. If not diagnosed and treated promptly, the consequences can be very serious. Here, we shared a successful diagnosis and treatment case of DNM that originates from oral to neck and mediastinum caused by Streptococcus constellatus (S constellatus). S constellatus is a clinically uncommon gram-positive coccus and is known for its ability to form abscesses. Timely surgical drainage and the correct use of antibiotics are key to successful treatment.
METHODS: A 53-year-old male admitted to hospital with painful swelling of the right cheek, persistent oral pus and moderate fever lasting 1 week, followed by rapid development of a mediastinal abscess.
METHODS: He was diagnosed with DNM caused by S constellatus.
METHODS: On the evening of admission, an emergency tracheotomy and thoracoscopic exploration and drainage of the right mediastinum, floor of the mouth, parapharynx and neck abscess were performed. Antibiotics were administered immediately.
RESULTS: At 28 days post-operatively, the abscess was absorbed, bilateral lung exudate decreased and the patient temperature, aspartate transaminase, alanine transaminase, bilirubin and platelets returned to normal. The patient was discharged after completing 4 weeks of antibiotic therapy. Follow-up at 3 months after discharge revealed no recurrence of the abscess.
CONCLUSIONS: Early surgical drainage and antibiotics treatment are important in mediastinal abscesses and infectious shock due to Streptococcus asteroids.